Snapshot A 4-month old female was referred by a local clinic for evaluation of asymmetric thigh creases during routine checkup. Physical exam revealed that the left lower limb was shorter than the right and lay externally rotated. Hip abduction was limited to 30 degrees. Ortolani's test was positive. Radiographs revealed a superiorly displaced left proximal femoral metaphysis and a shallow, hypoplastic left acetabulum. The infant was treated in a Pavlik abduction harness for congenital hip dislocation. Introduction Most common orthopaedic disorder in newborns Developmental dysplasia/dislocation of the hip (DDH) A spectrum of conditions characterized by login to view 5 more bullets Results from poor development of the acetabulum and hip due to excessive uterine packing which causes excessive stretching of the posterior hip capsule and adductor muscle contractures Deformity will progress if it is not corrected Etiology Risk factors - the 4 F's females firstborns fanny first (breech presentations) family history of DDH Presentation Idenitfy through screening physical exam asymmetric skin folds limited hip abduction on affected side Barlow's test login to view 4 more bullets Ortolani's test login to view 4 more bullets Galeazzi's test login to view 2 more bullets Trendelenburg sign in walking patients login to view 2 more bullets Imaging Clinical exam Ultrasound Radiographs are unreliable until the patient is at least four months old because of radiolucency of femoral head Treatment < 6 months old Pavlik harness (abduction bracing) login to view 2 more bullets Can observe until up to 4 weeks of age to allow for spontaneous resolution without risk of jeopardizing future interventions 6-18 months old closed reduction and hip spica cast >18 months old open reduction followed by hip spica cast Complications Joint contractures AVN of the femoral head Prognosis Better if treatment begins earlier