Clinical reference

Developmental Dysplasia of the Hip Referral

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources1 source

AAP Clinical Practice Guideline: Early Detection of Developmental Dysplasia of the Hip 2016

Verified against1 document

AAP Clinical Practice Guideline: Early Detection of Developmental Dysplasia of the Hip 2016

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (1)

How it looks changes with age: mild instability and limited abduction in infancy, a limping gait in the toddler, hip pain in the teen years, and osteoarthritis in adulthood [groin pain · hip pain · limp]

Signs — what you find (10)

The Barlow and Ortolani maneuvers can pick up hip instability or dislocation
On Ortolani testing a felt jerk or clunk signals a dislocated hip, whereas an isolated click without instability is not significant
During Barlow's maneuver, the examiner may feel a distinct clunk when the femoral head slips out of the socket
In experienced hands these maneuvers are 87 to 97 percent sensitive and 98 to 99 percent specific
Uneven hip position or an unequal number of gluteal skin folds can suggest dysplasia, though this is also a normal variant in 27 percent of unaffected infants
The Galeazzi sign compares apparent knee height with both hips and knees flexed and the feet flat on the table
In older infants, abduction under 75 degrees or adduction past 30 degrees beyond midline suggests dysplasia
A Trendelenburg limp, exaggerated lower-back curve, toe walking, uneven leg lengths, or early hip arthritis can also point to dysplasia once past the newborn period [limp]
On a dislocated hip the Klisic line runs from the trochanter and iliac spine down to below the navel instead of at or above it
After about 4 months the joint capsule tightens, so Barlow and Ortolani testing may no longer be positive and limited abduction becomes the key finding

Tests (12)

Screening protocols call for imaging the hip - sonography around six weeks old, or a plain film by four months old - in at-risk girls
Cross-sectional imaging is mainly used once the hip has already been reduced and placed in a cast, to check its position
Because the femoral head ossific nucleus usually only appears between 4 and 6 months, x-ray becomes the preferred study over ultrasound past that age
A normal hip x-ray at 4 months reliably rules out dysplasia even in an at-risk child
On ultrasound the key measurement is femoral head coverage by the socket of at least 50 percent, with an alpha angle over 60 degrees considered normal
The Graf alpha angle, between the bony socket and the ilium, is normally greater than 60 degrees
The Graf beta angle, between the labrum and the ilium, is normally under 55 degrees
On x-ray, the Hilgenreiner line should pass above the femoral head
The Perkin line should run lateral to the femoral head, which should sit medial to it
Any break in the smooth Shenton line arc from the femoral neck to the obturator foramen signals an abnormality
The acetabular index should read under 35 degrees at birth and under 25 degrees by age one
The Wiberg center-edge angle, reliable only after age 5, should measure over 20 degrees

If not this — what else fits (4)

Proximal femoral focal deficiency is another cause of leg length inequality
A femoral neck fracture is another cause of leg length inequality
Coxa vara is another cause of leg length inequality
A prior joint infection leaving residual damage is another cause of leg length inequality

SourceStatPearls "Developmental Dysplasia of the Hip" - disease-level clinical article

Presentation findings are traced to the source above.

NO DRUG THERAPY REQUIRED (URGENT ORTHOPAEDIC REFERRAL)

1st line

Adult dose and duration

Urgent paediatric orthopaedic referral. Hip ultrasound under 6 months, X-ray over 6 months. No medicine treats this and none is needed. - Urgent referral

Paediatric dose

Urgent referral to pediatric orthopedics for hip ultrasound (if <6 months) or X-ray (if >6 months). No routine pharmacotherapy

Dose source

AAP Clinical Practice Guideline: Early Detection of Developmental Dysplasia of the Hip 2016

Why

Structural orthopaedic condition requiring urgent specialist referral for harness bracing; routine pharmacotherapy is not indicated.

Cautions

URGENT ORTHOPEDIC REFERRAL: Early diagnosis (<6 weeks) allows non-surgical treatment with Pavlik harness with >90% success.
The screening maneuvers are Barlow (dislocates unstable hip) and Ortolani (reduces dislocated hip).
The risk factors are female sex, breech presentation, family history of DDH, and swaddling with legs extended.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.