1. Double diapering is not an effective treatment of DDH.
  2. Skilled and quality ultrasound evaluation should be available.
  3. Acetabular index < 30 degrees is considered normal.
  4. Breech presentation is felt to be a particularly strong risk factor for DDH even in the face of a normal physical exam. Recommendation is for screening ultrasound at 6 weeks and a single AP pelvis radiograph at 6 months.
  5. Abduction orthosis of choice always includes repeat clinical exam, ultrasound/radiograph (age-dependent).
  6. Surgical intervention (closed reduction, arthrogram, open reduction, etc.) and post closed reduction CT or MRI always includes repeat clinical exam, ultrasound/radiograph (age-dependent).
  7. For patients age birth – 4 weeks, the treatment “repeat clinical exam” should be performed within 4 additional weeks.

Disclaimer:

Volunteer physicians from multiple medical specialties created and categorized these Appropriate Use Criteria. These Appropriate Use Criteria are not intended to be comprehensive or a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. These Appropriate Use Criteria represent patients and situations that clinicians treating or diagnosing musculoskeletal conditions are most likely to encounter. The clinician’s independent medical judgment, given the individual patient’s clinical circumstances, should always determine patient care and treatment.

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