Positive Ortolani and Barlow signs in a 6-month-old infant not previously noted in the medical record; what is the correct treatment?

Positive Ortolani and Barlow signs in a 6-month-old infant not previously noted in the medical record; what is the correct treatment?

• A. Spica cast
• B. Pavlik harness
• C. Surgical intervention
• D. Triple diapering

Answer: (B)

Positive Ortolani and Barlow signs mean the hip is unstable in an infant, consistent with developmental dysplasia of the hip. For a 6‑month‑old, the best initial treatment is a Pavlik harness. This device keeps the hip in flexion and abduction, guiding the femoral head into the acetabulum and allowing normal growth while avoiding a full surgical procedure. The goal is to achieve and maintain reduction nonoperatively, with regular clinical and imaging follow-up to ensure the hip stays reduced and to monitor for potential complications like avascular necrosis. If reduction cannot be achieved or maintained with the harness, or if the child is older or diagnosis is delayed, then surgical options such as closed reduction with a spica cast or open reduction become necessary. Spica casting is typically used after a successful reduction or in older infants, not as the first-line treatment for a reducible hip. Triple diapering is not effective for DDH management.

Positive Ortolani and Barlow signs mean the hip is unstable in an infant, consistent with developmental dysplasia of the hip. For a 6‑month‑old, the best initial treatment is a Pavlik harness. This device keeps the hip in flexion and abduction, guiding the femoral head into the acetabulum and allowing normal growth while avoiding a full surgical procedure. The goal is to achieve and maintain reduction nonoperatively, with regular clinical and imaging follow-up to ensure the hip stays reduced and to monitor for potential complications like avascular necrosis. If reduction cannot be achieved or maintained with the harness, or if the child is older or diagnosis is delayed, then surgical options such as closed reduction with a spica cast or open reduction become necessary. Spica casting is typically used after a successful reduction or in older infants, not as the first-line treatment for a reducible hip. Triple diapering is not effective for DDH management.