Ortolani test

Ortolani Test is a medical procedure used in the early detection of Developmental Dysplasia of the Hip (DDH) in infants. The test is named after Marino Ortolani, an Italian pediatrician who first described it in 1937. It is a critical examination for newborns and infants to prevent future hip dysplasia, which can lead to hip dislocation and osteoarthritis in the long term if left untreated.

Hip-joint, front view.

Right hip-joint from the front.

Procedure

The Ortolani Test is performed by a trained healthcare professional, usually during a newborn's first health examination and at subsequent well-baby visits. The infant is placed in a supine position (lying on the back). The examiner holds the baby's legs in a flexed position, with the knees bent and the thighs spread apart. Gentle pressure is then applied to move the thighs outward and upward. A positive Ortolani Test is indicated by a distinctive "clunk" sound or sensation, which suggests that the femoral head is moving back into the acetabulum, indicating potential DDH.

Significance

Early detection of DDH through the Ortolani Test is crucial for effective treatment. If diagnosed early, DDH can often be corrected using non-surgical methods such as a Pavlik harness, which helps to keep the hip in the correct position as it develops. Delayed diagnosis or treatment, on the other hand, may require more invasive procedures, including surgery, and can lead to long-term complications such as limp, hip pain, or hip osteoarthritis.

Limitations

While the Ortolani Test is a valuable tool for detecting DDH, it has its limitations. The sensitivity of the test decreases as the child ages, particularly after the age of 3 months, as the ligaments of the hip joint become tighter and the dislocated hip may become more difficult to reduce. Additionally, the test requires significant expertise to perform accurately, and there is a risk of false positives or negatives.

Complementary Tests

The Ortolani Test is often performed in conjunction with the Barlow Test, another examination for DDH. The Barlow Test checks for the possibility of dislocating a hip that is in its normal position, whereas the Ortolani Test checks for the ease of returning a dislocated hip to its normal position. Together, these tests provide a comprehensive assessment of hip stability in infants.

Conclusion

The Ortolani Test remains a fundamental part of neonatal orthopedic examination, essential for the early detection and treatment of DDH. Its effectiveness, however, is highly dependent on the skill and experience of the healthcare provider performing the test. Early diagnosis and treatment are key to preventing the long-term complications associated with untreated DDH.

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