Board of Directors Tackles a Variety of Topics During All-day Meeting

By: Donna J. Malert, CAE, and Terry Stanton

Board approves AUC, shows appreciation for outgoing members

The AAOS Board of Directors was exceptionally productive during its meeting on Monday.

The Board appointed the chair of the 2019 Nominating Committee; approved an Appropriate Use Criteria (AUC) for the Management of Development Dysplasia of the Hip in Infants Up to 6 Months of Age (for both the orthopaedic specialist and general pediatricians); approved a position statement on Principles for Musculoskeletal Based Patient Reported Outcomes—Performance Measure Development; and accepted or approved reports from various groups.


The 2017–2018 AAOS Board of Directors and council and cabinet chairs during Monday’s Board of Directors meeting.

The Board also presented certificates to several retiring board members and two council and cabinet chairs, whose terms end with the conclusion of the AAOS 2018 Annual Meeting, recognizing the efforts of those individuals on behalf of the Academy.

Nominating Committee update

The Board appointed David D. Teuscher, MD, an AAOS past president, to serve as chair of the 2019 Nominating Committee. At tomorrow’s Association Business Meeting, nominations for the other members of the 2019 Nominating Committee will be accepted from the fellowship. Five members will be elected by the full fellowship after the Annual Meeting. The 2019 Nominating Committee will be responsible for selecting the slate of officers and other positions for the upcoming year.

New AUC on DDH offers guidance

Based on the Academy’s previously issued Clinical Practice Guideline (CPG) on DDH, this new AUC is noteworthy for providing two versions, customized for the generalist/pediatrician and for the orthopaedic surgeon.

The Academy’s AUCs are online tools ( that process patient characteristics and variables as entered by physicians and use algorithms to indicate appropriate treatment paths, with the focus on those involving nonsurgical management.

The physician panels developing the AUC crafted a separate tool for the generalist because pediatricians and family physicians are those most likely to first assess infants for DDH.

“Pediatricians are often on the first line of evaluating these patients, and this tool helps them to be more aware of the risk factors. In that way, it aids them in developing the best course of action for their patients,” said Antonia F. Chen, MD, MBA, AUC section leader, AAOS Committee on Evidence-Based Quality and Value.

The AUC incorporates two significant recommendations, both supported with evidence characterized as Moderate, of the underlying CPG, including:

  • Evidence does not support universal ultrasound screening of newborn infants.
  • Evidence supports performing an imaging study before 6 months of age in infants with one or more of the following risk factors: breech presentation, family history, or history of clinical instability.

Even in the face of normal findings on physical examination, the AUC gives special weight to the variable of breech presentation. For breech-birth patients, the AUC counsels a screening ultrasound at 6 weeks of age and a single anteroposterior radiograph at 6 months of age.

To underscore the point for the primary care physician, the online tool displays a green-box popup when breech presentation is entered (Fig. 1).

“The pediatrician would be first to consider the next steps,” explained Julie Balch Samora, MD, PhD, MPH, the moderator for the AUC writing and voting panels. “It is important for primary care providers to understand the most concerning risk factors, and this AUC helps ensure appropriate knowledge by all providers. The panel identified the strongest risk factor as breech presentation and recommends a six-month plain radiograph for any infant with this significant risk factor.”

Both Dr. Samora and Dr. Chen noted that, as with all AUCs and their underlying CPGs, this product is offered as a tool to aid the physician in determining the optimal course of treatment, or nontreatment, for each patient.

“These are suggestions and recommendations based on the best evidence, not hardline commands that must be followed,” Dr. Chen said. “Every patient and clinical scenario should be evaluated on an individual basis.”

The panels developing the AUC included representatives from the American Academy of Pediatrics, the Pediatric Orthopaedic Society of North America, the Society of Diagnostic Medical Sonography, American College of Radiology, the Society for Pediatric Radiology, and the American Institute for Ultrasound in Medicine.

Additional business

The Board also held a number of strategic discussions and took action on several matters, including:

  • approved revisions to the AAOS Investment Policy Statements
  • approved recommendations from the Committee Appointment Program Committee
  • approved the 2018 strategic priorities
  • discussed the Strategic Plan Project Team’s report
  • discussed the Governance Task Force’s report

Recognition of leaders with expiring terms

At the conclusion of the meeting, AAOS President William J. Maloney, MD, recognized the service of those Board members and council and cabinet chairs whose terms end with the conclusion of the AAOS 2018 Annual Meeting. They include the following:

  • Evan L. Flatow, MD, chair of the Council on Education
  • Alan S. Hilibrand, MD, MBA, chair of the Communications Cabinet
  • Robert H. Brophy, MD, member-at-large
  • Brian S. Galinat, MD, MBA, member-at-large
  • Lisa K. Cannada, MD, chair of the Board of Specialty Societies
  • Daniel K. Guy, MD, chair of the Board of Councilors
  • Gerald R. Williams Jr, MD, past president

The Academy will continue to keep the membership informed of important happenings via articles in AAOS Now, email communications, and website updates.

Donna J. Malert, CAE, is director of governance at AAOS. She can be reached at Terry Stanton is the senior science writer for AAOS Now. He can be reached at