What are the key clinical signs to look for during a physical examination to assess for DDH in infants?

During a physical examination to assess for developmental dysplasia of the hip (DDH) in infants, the key clinical signs to look for include the Barlow and Ortolani maneuvers, which test for hip instability by attempting to dislocate and then relocate the femoral head respectively.

The Barlow test involves adducting the hip and applying gentle posterior pressure to see if the hip can be dislocated out of the socket, indicating instability.

The Ortolani test involves abducting the hip and lifting the femoral head anteriorly to check if a dislocated hip can be reduced back into the acetabulum, often felt as a palpable or audible 'clunk'.

Additional signs include asymmetry in thigh or gluteal skin folds, which may suggest hip displacement, and limited hip abduction on the affected side when the infant is supine with hips flexed.

Leg length discrepancy or apparent shortening of the femur on the affected side (Galeazzi sign) can also be observed in older infants.

These clinical signs are essential components of newborn screening for DDH and should be performed routinely in the first few weeks of life to identify infants at risk early ¹ (Shorter et al., 2011; de Hundt et al., 2012; Zhang et al., 2020).