**7. Treatment**

Treatment will depend on the age at which the diagnosis is made; the best prognosis is obtained at the beginning of the management in the newborn. In teratological dislocation, the management will always be surgical. In the subluxable hip, wide and thick cushions are used to maintain abduction of the hips bilaterally; they are used for a time in months that is calculated by multiplying the age in months by two when making the diagnosis; monthly clinical control should be performed. Recommending the use of a double diaper should be avoided, because disposable diapers do not maintain hip abduction [11, 17].

In the dislocated and dislocated hip, the abduction of the thighs is achieved, giving stability to the hips, with the use of the Pavlik harness, Fredjka cushion, Von Rossen splint, Barlow splint; These devices remain in place until a stronger joint capsule is obtained, which is achieved in 3 to 6 months.

If the child is already walking and the hip problem has not been detected, the treatment can be surgical and in severe cases, in the event of necrosis of the femoral head, place a prosthesis.

### **8. Discussion**

When receiving a newborn, a checklist for risk factors should be applied, already indicated as suggested by Ömeroğlu et al. [23], and if the infant has one or more, should undergo a Graf ultrasound of the hips to establish whether there is a diagnosis of DDH. The use of clinical tests such as Ortolani, Barlow and others should be

postponed until the fourth day of extrauterine life, since there will be false positives due to the processes of Birth, such as passage through the birth canal or potentially the effects of relaxin.

From the fourth day of life, comparative sound transmission tests can be applied, which have shown good sensitivity compared to hip ultrasound [12, 13, 35–37], unlike the usual clinical maneuvers that show low sensitivity for DDH [13, 35, 37].

Why to use sound transmission tests? **Table 1** show validity of the sound transmission test and sound transmission test with extension/flexion.

The compared sound transmission test evaluate both hips, if them have dysplasia, the test give a false negative; this is avoid using the compared sound transmission test with extension/flexion,

It was reported, sensitivity for Ortolani de 5.11%, specificity 96.77%, positive predictive value 69.23%, and negative predictive value 41.81% [13].

For Barlow test, Padilla et al. [13] reported 2.27, 99.19, 80.00, and 41.69%, respectively.

For repeatability, Padilla et al. [35] reported Kappa 0.80 intra-observer and 0.70 inter-observer, for compared sound transmission test and, Kappa.88 and 0.78, intra-observer and inter-observer, respectively, for the sound transmission test with extension/flexion.

With electroacoustic probe, the repeatability was Kappa 0.80 intra-observer and 0.81 inter-observer for compared sound transmission; 0,98 intra. Observer and 0.95 inter-observer, for compared sound transmission with extension/flexion [37].

Since the 80's of the 20th century, the use of ultrasound of the hips has been recommended instead of radiographs in the newborn and in infants less than 8 weeks of extrauterine life, since with radiography, diagnostic errors are generated due to the lack of ossification of the femoral head mainly.

If the presence of DDH is adequately orthopedically treated, the cure is complete with an excellent prognosis, and this is darkened if it comes to surgical treatment.


#### **Table 1.** *Validity of the sound transmission tests.*

*Diagnosis of Developmental Dysplasia of the Hip in Newborns and Infants DOI: http://dx.doi.org/10.5772/intechopen.104085*

In infants, DDH is treated with a Fredjka cushion or Pavlik harness; the double diaper should not be used; if the child is already ambulant, he should be evaluated for surgical treatment of the hip joint. And in this phase, the presence of necrosis of the femoral head should be assessed, since this will lead to the placement of a prosthesis.

The objective of diagnosis and treatment is that the child does not reach the stage of ambulation with DDH and avoid surgical treatment, which is a major procedure.

### **9. Conclusion**

It is a pathology that can go unnoticed and its best prognosis is to detect and treat it before 6 months of age.

The health professional in charge of the care of neonates and infants, should be attentive at each visit, of the state of the hips of each child, applying the usual clinical maneuvers and sound transmission tests, and, if necessary, ultrasound of the hips, and with this, is possible to establish an early diagnostic of DDH.

The objective is to avoid that infants suffer corrective surgery of the hip and/or replacement of the hip.

### **Acknowledgements**

Not funding for this manuscript.
