Congenital hip dysplasia is the improper formation and function of the hip socket. Detecting developmental or congenital hip dysplasia in newborns is essential because the longer the condition goes undetected and untreated, the more difficult it is to correct.
Assessment and examination in newborns is vital to detect congenital hip dysplasia. Early detection promotes timely intervention to any abnormality noted in infants. Nurses should have extensive knowledge on these assessment tests to start an early treatment just as early as the condition was suspected.
Ortolani Test (steps 1-5)
Ortolani test or Ortolani Maneuver is a physical examination for congenital hip dysplasia or developmental hip dysplasia. The test was named after Marino Ortolani, the person who developed it in 1937. The maneuver is performed by abducting the infant’s hip an assessing for a clicking sound.
This test is used to detect the posterior dislocation of the hip. A positive Ortolani’s sign is noted when a clicking or distinctive “clunk” is heard when femoral head re-enters the acetabulum.
Ortolani maneuver is performed before 2-3 months of age. The maneuver is done in early infancy because after 2-3 months the development of soft tissue contracture prevents the hip from being relocated, thus, no clicking or clunking sound will be assessed in children with congenital hip dysplasia.
Barlow Test (steps 6 and 7)
Barlow test is a maneuver performed by bringing the thigh towards the midline of the body. Feeling of femoral head slipping out of the socket postolaterally, is considered as a positive Barlow’s sign.
The Ortolani test is then used to confirm that the hip is actually dislocated.
- Lay the infant in a supine position and flex the knee to 90 degrees at the hips. Proper positiong of the infant ensures accurate results.
- Hold the infant’s pelvis with one hand to stabilize it during manipulation.
- Using the other hand, the place the middle fingers over the great trochanter of the femur and the thumb on the internal side of the thigh over the lesser trochanter. Placing the fingers in this manner allows easy abduction of the hips.
- Slowly and gently abduct the hips while applying pressure over the greater trochanter. The femur is pulled forward while the greater trochanter is used as a fulcrum.
- Listen for a clicking or clunking sound while performing step number four. Normally, no sound is heard. A clicking or clunking sound is a positive Ortolani’s sign and it happens when the femoral head is re-entering the acetabulum.
- With the fingers in the same position, assess the infant for Barlow’s sign. Hold the hips and knees at 90 degree flexion while exerting a backward pressure (down and laterally).
- Slowly and gently adduct (bringing the thigh towards the midline) the hip. Note any feeling of the femoral head slipping. Normally, the hip joint is stable. The feeling of the femoral head slipping out of the socket postolaterally is a positive Barlow’s sign.
Source: Maternal and Child Health Nursing by Pillitteri, 5th Ed
Image from orthopediatrics.com, www2.massgeneral.org