Synopsis
Detect hip instability and acetabular underdevelopment at the age when treatment is least invasive, interpret screening correctly and coordinate harness, reduction and residual-dysplasia surveillance without causing iatrogenic harm.
- DDH ranges from shallow acetabulum to a dislocatable or fixed dislocated hip; early disease may be entirely painless and visually subtle.
- NIPE examines hips within 72 hours of birth and again at six to eight weeks, using Ortolani and Barlow manoeuvres plus later abduction and leg-length assessment.
- A true Ortolani clunk is the femoral head reducing over the acetabular rim; a soft click without translation is not equivalent.
- First-line imaging for a young infant is dynamic hip ultrasound, targeted at about four to six weeks for national risk factors or abnormal examination.
- After femoral-head ossification, AP pelvic radiography becomes the reference structural study for acetabular index, head position and residual dysplasia.
- First-line treatment for a stable reducible early hip is a supervised Pavlik harness holding flexion while allowing safe abduction; double nappies do not treat DDH.
- Failure of harness treatment or later fixed dislocation requires examination under anaesthesia, arthrogram and closed reduction with spica, or open reduction when concentric stability cannot be achieved.
- Continue radiographic follow-up after successful reduction because residual dysplasia can persist silently and may require femoral or pelvic osteotomy.
Key red flags
A palpable Ortolani clunk as the femoral head reduces is pathological and requires direct specialist assessment even if later examinations appear normal.
Markedly limited or asymmetric abduction after the neonatal period is a more useful late sign than skin-fold asymmetry alone.
Leg-length inequality, positive Galeazzi sign, unilateral toe walking or waddling after walking begins indicates late displacement until proved otherwise.
Breech presentation and a first-degree family history requiring DDH treatment trigger the national selective ultrasound pathway despite a normal examination.
A warm painful hip, fever, reduced feeding or refusal to move the limb suggests infection, not uncomplicated developmental dysplasia.
A harnessed infant with absent kicking, femoral-nerve weakness, skin injury or a hip that remains unreduced needs urgent treatment-team review.
Investigation priorities
Assess acetabular morphology, femoral-head coverage and dynamic stability before substantial ossification.
Management branches
A newborn or young infant attends routine examination or has a recognised DDH risk factor.
- Perform gentle bilateral stability, abduction, leg-length and associated-condition examination at the specified newborn and six-to-eight-week contacts.
- Arrange targeted ultrasound at the national programme interval for abnormal examination or qualifying breech or family risk.
- Refer a clinically dislocated hip directly rather than waiting for routine screening administration.
- Record completion and chase non-attendance because an unperformed scan is not a negative result.
The hip is irreducible, harness treatment fails or diagnosis occurs beyond the early harness window.
- Plan examination under anaesthesia and arthrogram with adductor release when required.
- Use gentle closed reduction and hip spica only when a concentric position remains stable within a safe abduction range.
- Proceed to open reduction when tissue blocks or instability prevent safe closed treatment.
- Confirm cast position and monitor perfusion, pressure areas, hygiene and redislocation throughout spica treatment.