A 6 week old infant has positive Barlow and Ortolani maneuvers. What test should the NP order for developmental dysplasia of the hip (DDH)?

In the case of a 6-week-old infant who presents with positive Barlow and Ortolani maneuvers, the most appropriate test to order for developmental dysplasia of the hip (DDH) is an ultrasound of the hip.

Ultrasound is particularly valuable in this age group because it can visualize the hip joint's soft tissues, including the acetabulum and femoral head. This is crucial for identifying potential dysplasia or instability before the bones have fully ossified. Since infants less than 4 to 6 months have cartilaginous ossification, ultrasound provides the necessary imaging without exposing them to radiation, which is particularly important in very young patients.

In contrast, while plain hip x-rays and frog leg x-rays can provide valuable information about the hip joint, they are less useful before the age when the bones have fully developed, typically around 4 to 6 months. At this stage, changes of DDH may not be visible due to the lack of ossification. CT scanning is generally not indicated in this scenario for diagnosing DDH due to its higher radiation exposure and the availability of other safer imaging modalities.

Thus, the choice of ultrasound is the optimal approach for evaluating potential DDH in an infant of this