Strategies to improve nonoperative childhood management.

Early diagnosis is of paramount importance to favorably alter the natural history of DDH. Most cases of dysplasia can be diagnosed by careful history taking and physical examination. Imaging modalities, such as ultrasonography, have increased our ability to detect subtleties not appreciated by means of physical examination or plain radiography. Although the evaluation of children with risk factors for DDH is important, most dysplasia occurs in girls who have no other risk factors. For all infants, a competent newborn physical examination using the Ortolani maneuver is the most useful procedure to detect hip instability. Early treatment of an unstable hip with a Pavlik harness or similarly effective orthosis is effective, safe, and strongly advised.