HipNewborn – 18 months
Developmental Dysplasia of the Hip (DDH)
A spectrum of hip instability ranging from a dysplastic but reduced hip to a frankly dislocated hip, related to abnormal development of the acetabulum and proximal femur.
Presentation
- Asymmetric thigh skin folds and limited hip abduction
- Positive Ortolani (reducible) and Barlow (dislocatable) signs in neonates
- Galeazzi sign with apparent limb-length discrepancy
Imaging & Workup
- Ultrasound is the study of choice before 4–6 months of age (Graf classification)
- AP pelvis radiograph after ossific nucleus appears (~4–6 months)
- Assess acetabular index, Shenton line, and Hilgenreiner/Perkin quadrants
Treatment
Pavlik harness
First-line for infants < 6 months; maintains flexion and abduction.
Closed reduction & spica
6–18 months or failed harness; confirm reduction with arthrogram.
Open reduction
For irreducible hips or older children, often with osteotomy.
Clinical Pearls
- Breech presentation and family history are major risk factors
- Avoid forced abduction — risk of osteonecrosis
- Earlier detection dramatically improves outcomes