Description of the 'pronation manoeuvre' for the diagnosis of developmental hip dysplasia
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Published on: July 7, 2016
José Fernando de-la-Garza-Salazar1,2, Julieta Rodríguez-de-Ita1,3, Bárbara M Garza-Ornelas1
1Tecnologico de Monterrey, School of Medicine and Health Science, Monterrey, Mexico.
Insights
A new pronation maneuver shows promise for screening developmental dysplasia of the hip (DDH) in infants. This tool offers higher sensitivity than traditional Ortolani and Barlow maneuvers, potentially improving early DDH diagnosis.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Neonatal Screening
Background:
- Developmental dysplasia of the hip (DDH) in infants can lead to severe long-term complications if not diagnosed early.
- Current screening relies on Ortolani and Barlow maneuvers, which have demonstrated low sensitivity in detecting DDH.
- Improved screening tools are crucial for timely intervention and better patient outcomes.
Purpose of the Study:
- To evaluate the diagnostic performance of a novel physical examination technique, the pronation maneuver, for screening DDH in infants.
- To compare the efficacy of the pronation maneuver against established Ortolani and Barlow maneuvers.
Main Methods:
- A cross-sectional, analytical study was conducted using nonprobabilistic sampling.
- Infants with positive Ortolani or Barlow maneuvers underwent evaluation with the pronation maneuver and hip ultrasound.
- Control infants with negative results for all three maneuvers also underwent hip ultrasound.
Main Results:
- DDH was confirmed in 64% of cases (83/130) and 2% of controls (2/130).
- The pronation maneuver exhibited a sensitivity of 76% and a specificity of 94%.
- This significantly outperformed the Ortolani and Barlow maneuvers (sensitivity 31-32%, specificity 93-100%, P<0.05).
Conclusions:
- The pronation maneuver presents a valuable addition to the clinical toolkit for initial DDH screening in newborns.
- Its superior performance compared to traditional methods may enhance the diagnosis and prognosis for infants with DDH.
Introduction:
Without a prompt diagnosis, developmental dysplasia of the hip (DDH) in infants can lead to severe sequelae. Current screening strategies emphasize the use of Ortolani and Barlow physical examination manoeuvres, yet they exhibit low sensitivity. The purpose of this study is to evaluate the performance of a new physical examination tool (the pronation manoeuvre) as a screening tool for DDH.
Methods:
To evaluate the new manoeuvre, a cross-sectional and analytic study was performed with a nonprobabilistic sampling method. Patients with either a positive Ortolani or Barlow manoeuver were evaluated with the new manoeuvre and hip ultrasound. Controls were infants with negative Ortolani, Barlow and pronation manoeuvres and also had ultrasound performed.
Results:
DDH was confirmed in 83 of 130 cases (64%) and 2 of 130 controls (2%). The new pronation manoeuvre had a sensitivity of 76% and a specificity of 94% as compared to the Ortolani and Barlow manoeuvres (sensitivity 31 to 32%, specificity 93 to 100%) (P<0.05).
Conclusion:
This new physical examination manoeuvre could serve as another clinical tool for the initial screening of DDH in newborns. Its promising results against traditional screening procedures might potentially impact diagnosis and prognosis for patients with DDH.
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