The diagnosis of DDH is sometimes missed in pediatric practice.
The examiner must try to feel the hip move in and out of the joint
with delicate pressure over the knee and greater trochanter. Sometimes
it is easy to feel this, and at other times the finding is missed
or not there at all. The exam is hard to teach because the babies
with this finding are few. Consequently, the examiner must have
a high index of suspicion based on the presence of known risk factors.
Ultrasound examination and orthopedic referral are appropriate for
babies with breech presentation, especially females, for those with
a positive family history, for firstborn girls, and for any with
abnormal exam findings.2 For further information,
see Chapter 215.