From The limping child

	was it missed in routine screening?
Etiology	Hip instability, either typical (in normal infants) or teratological.
Epidemiology	Risk factors: - Female gender - First born child - First-degree relative or family history of DDH - Birth weight >4000g - Oligohydramnios during pregnancy - Caesarean birth - Breech presentation
Clinical presentation	uneven skin creases, limb length discrepancy, delayed walking, painless limp Asymmetrical buttock creases not sensitive! Galeazzi sign (knee uneven heights when patient lying supine)miles Ortolani + Barlow for screening (see below)
Pathogenesis
Diagnostic investigations	Ultrasound!
Management	Pavlik harness (maintain hip in flexion-abduction) + surgical reduction if not stabilised. Screening: at birth, and before 6w with risk factors. Less useful with ↑ age

manoeuvres


Barlow	trying to dislocate hip/feeling for a bump	abduct + push posteriorly	positive when you feel hip dislocate?
Ortolani	trying to relocate hip out of place	abduct + lift greater trochanter forward	positive: clunk of dislocated hip. Clicky hips can be normal - refer if unsure; or abduction < 60º