This section contains pictures and/or video of newborn genitalia and is intended for educational purposes only.
Breech Position
When an infant has been in breech position in utero, the legs have a tendency to remain in this position for the first few days. As with any positional deformity, spontaneous resolution is anticipated. Although infants born breech have a higher risk of Developmental Dysplasia of the Hip (DDH), this leg position does not, of itself, indicate any problems with the hips.
photo by Janelle Aby, MD
Leg Creases
Looking for asymmetry between the major creases in the thighs is another way to evaluate for DDH (Developmental Dysplasia of the Hip). This infant appears to have some asymmetry of the most superior creases. Initially, some slight amount of subluxation was felt on the Barlow exam in this baby, but it was not reproducible. This finding is more useful in older children as 25% of infants with normal hip exams may also have asymmetric creases.
photo by Janelle Aby, MD
Galeazzi Sign
Hips can also be assessed by looking at the symmetry of the height of the knees when the infant is supine. A positive galeazzi sign (unequal knee heights) suggests a unilaterally dislocated hip. It is important to remember that bilateral dislocations will likely appear symmetric, so this assessment should only be used in combination with the Ortolani and Barlow maneuvers. The infant in this photo has a negative galeazzi -- the hips are normal.
photo by Janelle Aby, MD
Galeazzi Sign
With a side few of the same infant in the previous photo, the knees still appear symmetric. Again, this is a negative Galeazzi.
photo by Janelle Aby, MD
Galeazzi Sign
In contrast, this infant has a positive Galeazzi sign. With both feet placed firmly on the table, the knees are not symmetric. This finding is usually caused by a dislocated femoral head which is situated posterior to the acetabulum, instead of in the acetabular fossa. This creates a shortened appearance of the thigh on the affected side. In this case, the left hip was the abnormal one.
photo by Janelle Aby, MD
Galeazzi Sign
This is the side view of the same infant as in the previous photo. Again, the left knee is slightly lower than the right (although in this view the difference seems less pronounced). This infant was treated with a Pavlik harness and did well.
photo by Janelle Aby, MD
Pavlik Harness
When instability of one or both hips is noted, an orthopedic consult should be obtained. In many cases, a pavlik harness will be placed before the infant is discharged from the nursery. While it is a velcro apparatus and can be easily removed, the family is frequently instructed not to remove it for some time, so care should be taken to ensure that all newborn bands are removed from the ankles first.
photo by Janelle Aby, MD
Abnormal Hip Abduction
Normally, the hips can abduct widely at birth. In this infant, the degree of limitation of abduction is clearly visible. Limited abduction can be a sign of DDH, so it is a useful tool in assessment, especially for older infants when Ortolani and Barlow maneuvers are not helpful. The infant in this photo also has abnormalities of other joints -- in this case, the evaluation should extend well beyond the hips.
