- early dx by postnatal screening w/ Ortolani or Barlow's Test
is essential to detect hip instability or dislocation;
- strictly interpreted, the Ortolani sign is the palpable sensation of the gliding of the femoral head in and out of the acetabulum;
- femoral head glides back and forth over a ridge of pathologic hypertrophic acetabular cartilage as the femoral head enters and leaves the acetabulum;
- others have interpreted the Ortolani sign as the palpable reduction of an infant's dislocated hip where as the Barlow's Test
is used to describe the provoked
dislocation of an unstable hip by gently adducting flexed hip while pushing posteriorly in line of shaft of femur;
- Ortolani test identifies dislocated hip that can reduced in early weeks of life;
- a positive test requires active treatment (see treatment in newborns
- if hip remains dislocated (for weeks), limitation of abduction becomes more consistent clinical finding.
- w/ time, it becomes more difficult to reduce femoral head into acetabulum, and the Ortolani test becomes negative;
- w/ this in mind, an infant w/ DDH and a negative Ortolani sign would not
be a good candidate for a Pavlik harness
- hips are examined one at a time;
- flex infant's hips & knees to 90 deg;
- thigh is gently abducted & bringing femoral head from its dislocated posterior position to opposite the acetabulum, hence reducing femoral
head into acetabulum;
- in positive finding, there is a palpable & audible clunk as hip reduces;
- Three Stages of Subluxation:
- dislocated (+ Ortolani)
- dislocatable (+ Barlow
- subluxatable (Barlow suggestive)
Screening the Newborn for Developmental Dysplasia of the Hip: Now What Do We Do?
Original Text by Clifford R. Wheeless, III, MD.