Ortolani Test

What is a hip dislocation?

Hip dislocation in infants, also known as congenital hip dislocation, is a form of developmental dysplasia of the hip (DDH) in which the femoral head is not properly aligned with the acetabulum. This condition presents with varying degrees of hip instability, ranging from mild displacement (subluxation) to a complete dislocation, where the femoral head is entirely out of the socket.

Common hip dysplasia presentations include restricted hip abduction, asymmetrical thigh or gluteal folds, and tight hip adductors, which may limit movement. Early detection through clinical tests, such as the Ortolani and Barlow maneuvers, is essential for timely intervention. Proper management can help ensure normal hip development and prevent long-term complications.

Symptoms of hip dislocation

Infants with congenital hip dislocation or DDH may not always show obvious signs at birth. However, key hip dysplasia presentations include:

• Hip instability: The hip may feel loose or dislocated during movement.
• Restricted hip abduction: Limited outward movement of the affected hip, especially noticeable during diaper changes.
• Asymmetrical thigh or gluteal folds: Uneven skin creases in the thighs or buttocks due to improper hip positioning.
• Tight hip adductors: Stiffness or resistance when spreading the legs apart.
• Leg length discrepancy: The affected leg may appear shorter if the femoral head is displaced.
• Audible or palpable "click" or "clunk": Detected during Ortolani or Barlow maneuvers, indicating hip instability.

Problems hip dislocation causes

If left untreated, hip dislocation can lead to several complications affecting mobility and overall hip function, including:

• Delayed walking or abnormal gait: Children may develop a limp or a waddling gait due to misalignment.
• Hip pain and stiffness: Increased strain on the hip joint can cause discomfort as the child grows.
• Leg length discrepancy: Persistent dislocation can lead to one leg appearing shorter than the other.
• Osteoarthritis and joint degeneration: Long-term misalignment can result in premature wear of the hip joint, increasing the risk of arthritis in adolescence or adulthood.
• Avascular necrosis (AVN): Severe cases may disrupt blood flow to the femoral head, leading to bone tissue death.

Early diagnosis and treatment, such as bracing or surgical intervention, are crucial to ensuring normal hip development and preventing future complications.

What is the Ortolani Test?

The Ortolani Test is a clinical examination used to detect developmental dysplasia of the hip, also known as developmental hip dysplasia in infants. Developed by Italian pediatrician Marino Ortolani, this test helps identify if the hip joint is correctly positioned in its socket. The test is particularly valuable because DDH can be asymptomatic and may not be visibly apparent. Early diagnosis through the Ortolani Test can lead to timely treatment, which is crucial for normal hip development.

Typically, the Ortolani Test is paired with the Barlow Test to evaluate the hip's stability comprehensively. The Barlow Test is performed first to determine if the hip can be dislocated from its socket with gentle pressure, indicating instability.

Then, the Ortolani Test is done to check if a dislocated hip can be moved back into its correct position. This sequence is important because it tests both the dislocatability and the reducibility of the hip joint, covering a full spectrum of potential abnormalities.

How to use our Ortolani Test template

Our Ortolani Test template is designed to streamline documenting and evaluating the test's outcomes, ensuring that you can efficiently record essential details and facilitate ongoing care. Here's how to make the most of this resource:

Step 1: Access this template

First, you need to access the template via the Carepatron app by clicking the "Use template" button. If you open it in the app, you can also customize it and share it with the patient or other healthcare professionals on the app. For a PDF copy, just click "Download."

Step 2: Explain the template

Before performing the test, explaining the procedure to the parents or caregivers is crucial. Use the template to go through each section, explaining what information will be recorded and why it is important.

Step 3: Fill out the template during the examination

As the Ortolani Test is conducted, fill in the template in real time. This documentation ensures accuracy and provides a detailed record that can be referred to later or shared with other specialists.

Step 4: Utilize the results section

After the test, complete the results section of the template. This may involve marking whether the test was positive or negative and detailing the next steps, such as referrals to specialists or additional imaging required. This section is crucial for ensuring the follow-up plan is clear and actionable.

Utilizing our Ortolani Test template can enhance the efficiency and effectiveness of newborn screenings for a dysplastic hip, ensuring that critical information is accurately captured and appropriately acted upon.

Next steps after interpreting results

After performing the Ortolani Test and interpreting the results, healthcare professionals follow several key steps to ensure appropriate follow-up and management:

• Referral: If the Ortolani Test results are positive, indicating a dislocated hip that successfully relocates during the test, the immediate step is to refer the infant to a pediatric orthopedic specialist. These specialists can provide a detailed assessment and confirm the diagnosis with imaging studies such as ultrasound or X-rays.
• Treatment planning: Treatment options may vary depending on the severity of the hip dysplasia and the child's age. Common interventions include using a Pavlik harness, which helps hold the baby's hip in the correct position to encourage normal development. In more severe cases, surgical interventions might be necessary.
• Monitoring and follow-up: Regular follow-up appointments are critical to monitor the hip's development and the effectiveness of the treatment plan. These check-ups allow adjustments as needed and ensure that the hip develops normally.
• Parental guidance and support: Educating the parents or caregivers about the condition, treatment plan, and the importance of follow-up care is essential. Providing clear instructions and support helps ensure adherence to treatment protocols and reduces anxiety associated with the diagnosis and management of hip dysplasia.

By following these steps, you can effectively manage developmental dysplasia of the hip and improve outcomes for affected infants.