Ultrasonography in the Diagnosis and Management of Developmental Dysplasia of the Hip.

Graf's technique for static anatomic assessment of the hip is widely accepted as part of developmental dysplasia of the hip (DDH) evaluation and is the foundation for other, more dynamic techniques utilized today. The low cost and lack of ionizing radiation of ultrasound have encouraged some international communities to implement ultrasound in universal screening. The technique's limitations with regard to high intraobserver and interobserver variability in interpretation, along with controversy about the efficacy of universal screening, have led to the 2018 American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria for the Management of Developmental Dysplasia of the Hip to recommend selective screening. Dynamic ultrasonography, first described by Harcke in 1984, has become a more commonly used ultrasonographic method. Harcke's method of dynamic ultrasonography allows for the real-time assessment of an infant's hip and can be performed with and without stress maneuvers in both the coronal and transverse planes of a neutral and a flexed hip. A pediatric orthopaedic surgeon should have a fundamental understanding of ultrasonographic technique, its indications, and its limitations to appropriately utilize it in the neonatal period.