[Physical diagnosis--Ortolani's manoeuvre]

Area of Science:

• Pediatric Orthopedics
• Neonatal Screening
• Developmental Dysplasia of the Hip

Background:

• Ortolani's manoeuvre is a clinical test to assess infant hip instability.
• It aims to detect the mobility of the femoral head within the acetabulum.
• Barlow's modification is used to test for dislocation of a reduced, unstable hip.

Purpose of the Study:

• To evaluate the effectiveness of Ortolani's manoeuvre in preventing late diagnoses of hip dysplasia.
• To determine the advisability of general screening with Ortolani's manoeuvre in the Dutch context.
• To explore alternative screening methods for neonatal hip instability.

Main Methods:

• Review of the diagnostic utility of Ortolani's manoeuvre.
• Analysis of factors contributing to false-positive and false-negative outcomes.
• Consideration of ultrasound screening as a potential alternative.

Main Results:

• Widespread use of Ortolani's manoeuvre does not prevent all late diagnoses of hip dysplasia.
• The test's accuracy is limited by the need for a relaxed infant and an experienced examiner.
• General screening in the Netherlands is not advised due to variable physician/midwife experience, leading to unreliable results.

Conclusions:

• Ortolani's manoeuvre alone is insufficient for comprehensive hip dysplasia screening.
• The variability in examiner experience significantly impacts the reliability of Ortolani's manoeuvre.
• Ultrasound screening at child welfare clinics shows promise and is under investigation for improved detection rates.