Developmental dysplasia of the hip (DDH) is one of the most common congenital malformations encountered in pediatric clinical practice. It is not a single condition but rather a spectrum of abnormalities that can present in various ways. Dysplasia is defined as an alteration in the maturation of the structures that form the hip joint [1]. Overall, 1–2% of newborns are born with subluxated or dislocated hips, of which approximately 60% become stable within the first week and 88% by about two months of age [2]. The most important risk factors include female sex, a positive family history, breech presentation, post-term birth, and intrauterine growth restriction [3]. Neonatal screening, combining physical examination and ultrasound, is essential for the early diagnosis of DDH and for preventing the development of early hip osteoarthritis. From four months of age onward, diagnostic imaging is performed using an anteroposterior pelvic radiograph.

The Galeazzi–Allis sign is observed when the patient is placed supine with both hips flexed to 90°. An asymmetry in knee height indicates a positive sign, suggesting hip dislocation, and is associated with delayed detection. A timely diagnosis is key to effective treatment with a good prognosis.

A 10-month-old female infant, born to healthy parents with no significant medical history, was the product of a first pregnancy with normal prenatal care and no maternal illnesses. Anatomic and genetic ultrasounds showed no abnormalities. Delivery was by cesarean section due to breech presentation. Apgar scores were 9 and 9 at one and five minutes, respectively, and the Silverman–Anderson score was 0. Birth weight was 7.16 lb (3.25 kg), length 19.68 in (50 cm), and gestational age 38 weeks. Newborn hearing and cardiac screenings were normal, and metabolic screening was unremarkable. Well-child visits at 7 and 28 days of life revealed no abnormalities, but the patient was not followed up after that.

Reason for Consultation

Crawling Disorder: The mother reported that the baby began crawling at eight months; however, by nine months she noticed the infant was moving around in a sitting position on her left lower limb, propelling herself with the contralateral limb. The mother denied other symptoms such as crying, fever, or irritability. Physical examination revealed crawling in a seated position on the left lower limb, with propulsion from the right limb. The Galeazzi–Allis test was positive, and a shortening of the left lower limb was noted (Figures 1 and 2).

Figures 1 and 2: Positive Galeazzi-Allis test and shortening of the left lower extremity.

An anteroposterior pelvic and von Rosen radiograph was performed, revealing an absence of the left proximal femoral ossification center with loss of continuity of Shenton's arch and an acetabular index >32° (Figure 3).

Figure 3: Absence of the left proximal femoral ossification center. Source: clinical record.

A hip ultrasound was also performed, which was consistent with Graf type IIB hip dysplasia. The patient was referred to Pediatric Traumatology and Orthopedics for therapeutic advice.

Developmental dysplasia of the hip (DDH), formerly known as congenital hip dislocation, is the medical term used to indicate that the hip socket does not completely cover the ball and socket of the upper end of the femur. The main risk factors are: breech presentation, being female, a positive family history, and the presence of other deformities such as torticollis or congenital foot deformity [4]. Our patient had two risk factors for this condition: being female and having a breech presentation at birth.

The reported incidence worldwide is 1.5 cases per 1,000 newborns; the incidence in Mexico is generally 5 per 1,000 live births, but can vary between 2 and 15 per 1,000 live births depending on the diagnostic method used. DDH is more common in the left hip, as was the case in our patient; however, bilateral dysplasia is more common than right hip dysplasia [5].

Although clinical examination remains a fundamental pillar for diagnosing DDC in early childhood, not all cases are detectable by this diagnostic method, as it went unnoticed in our patient, perhaps because she did not attend her monthly routine appointments [6].

The Barlow and Ortolani maneuvers are only useful in the first 40 days of life; therefore, they were not useful in our patient. Later, the progression of the condition or the increase in the consistency of the periarticular tissues makes the maneuvers difficult to do. Asymmetry in limb length is useful when the alteration is unilateral; in extension of the lower limbs, a shortening will be observed on the side of the dysplastic hip, as occurred in our patient. Likewise, with the knees flexed and the feet resting on the same plane, preferably solid, the difference in height of one of the knees is observed (positive Allis or Galeazzi). This clinical sign was present and guided the diagnosis in our patient. Gait alterations were not observed; however, crawling while sitting was an alarming clinical finding that motivated us to investigate [7].

The International Hip Dysplasia Institute states that a frankly dislocated hip can occur with a completely normal physical examination: “There is no clinical method, even in expert hands, capable of reliably detecting babies with dislocated hips [8].

Currently in Mexico, the General Health Law and the National Health Card require a diagnosis of DDH through a physical examination and ultrasound or, failing that, an anteroposterior pelvic x-ray after the third month of life must be performed [9].

The authors emphasize the importance of using early clinical diagnostic methods to detect hip pathologies in a timely manner. In addition, a Graf ultrasound should be recommended for all patients, whether or not they have risk factors, to rule out any degree of hip dysplasia.

Conflict of Interest

The authors have indicated that they have no potential conflicts of interest to disclose.

Financial Disclosure

The authors have indicated that they have no financial relationships relevant to this article to disclose.

1. Raimann R, Aguirre D. Displasia del desarrollo de la cadera: tamizaje y manejo en el lactante. Rev medica Clin Las Condes. 2021; 32: 263-270.
2. Bakarman K, Alsiddiky A, Zamzam M, Alzain K, Alhuzaimi F, Rafiq Z. Developmental dysplasia of the hip (DDH): Etiology, diagnosis, and management. Cureus. 2023.
3. Nandhagopal T, Tiwari V, De Cicco F. Developmental dysplasia of the hip. Stat Pearls. Treasure Island (FL): StatPearls Publishing. 2025.
4. Jimenez J, Cadena P, Siguencia J, Curicho D. Displasia del desarrollo de caderas. Revista Cientifica Mundo de la Investigacion y el Conocimiento. 2022; 6: 316-326.
5. Olivo A, Redon A. Deteccion temprana clinica y radiologica basica de la displasia congenita de cadera en unidades medicas del primer nivel de atencion. 2016; 30: 67-72.
6. Verdezoto G, Condor L, Chimbo D, Yip M. Displasia del desarrollo de la cadera. Revista Científica Mundo de la Investigación y el Conocimiento. 2022; 6: 12-21.
7. Isunza A, Isunza O. Displasia de cadera. Acta Pediatr Mex. 2015; 36: 205-207.
8. Harper P, Joseph BM, Clarke NMP, Herrera-Soto J, Sankar WN, Schaeffer EK, et al. International Hip Dysplasia Institute (IHDI). Even Experts Can Be Fooled: Reliability of Clinical Examination for Diagnosing Hip Dislocations in Newborns. J Pediatr Orthop. 2020; 40: 408-412.
9. Isunza O, Lopez M. Manejo actual de la displasia de cadera. Lo que el pediatra debe saber Acta Pediatr Mex. 2024; 45: 540-544.