Clinical feature of ddh as infant and children
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developmental dysplasia hip clinical features infants children guideline examination limited abduction Galeazzi
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Clinical features of developmental dysplasia of hip (DDH)
| Age group | Clinical features |
|---|---|
| Newborn to <6 months | Often no obvious deformity. Hip instability is detected on screening: positive Barlow test (dislocatable hip) and/or positive Ortolani test (a palpable clunk as a dislocated hip reduces). There may be limited hip abduction, apparent limb shortening, and asymmetric thigh or gluteal folds, though skin-fold asymmetry alone is unreliable. |
| 6 to 18 months | Instability tests become less useful as soft-tissue contractures develop. The most reliable feature is restricted hip abduction on the affected side. Other signs are asymmetric thigh/gluteal folds and positive Galeazzi (Allis) sign: with hips and knees flexed, the knee is lower on the affected side due to apparent femoral shortening. |
| Walking child | Delayed recognition may present with a painless limp. Unilateral DDH causes a limp, positive Trendelenburg sign/gait, pelvic tilt, and apparent limb-length discrepancy. Bilateral DDH produces a waddling gait and increased lumbar lordosis. Parents may report difficulty spreading the thighs during diapering. |
Important examination points
- Examine the infant when calm, with one hip assessed at a time.
- A true palpable clunk in Ortolani or Barlow testing is significant. Benign hip “clicks” are nonspecific.
- In bilateral dislocation, the Galeazzi sign and asymmetry may be absent because both sides are similarly affected. Restricted abduction and a waddling gait are more helpful.
The age-related pattern above is described in Campbell’s Operative Orthopaedics, which notes that limited abduction is the first and most reliable later sign, while skin-fold asymmetry is neither sensitive nor specific. Campbell’s Operative Orthopaedics, p. 1403-1404. A clinical review similarly highlights instability in newborns and gait abnormality plus limited abduction in older children, as summarized by American Family Physician.
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