In developmental dysplasia of the hip (DDH), the Ortolani test demonstrates hip reduction — a 'clunk' as the dislocated femoral head re-enters the acetabulum. In which age group does this test become unreliable?
- A After 3 months of age, due to increasing muscle tone and soft-tissue contracture preventing easy relocation ✓
- B After 12 months when walking begins
- C Before 1 week of age due to physiological ligamentous laxity
- D Only reliable in preterm infants
Explanation
The Ortolani test (dislocation reduction manoeuvre) and Barlow test (subluxation provocation) are most sensitive and specific in the first 2–3 months of life when the hip is dislocatable and reducible. After 3 months, progressive soft-tissue contracture (capsular, iliopsoas, adductors) makes reduction by manual manoeuvre impossible, rendering Ortolani negative despite persistent dislocation. In infants >3 months, limb length discrepancy, asymmetric skin folds, restricted abduction, and imaging (ultrasound or X-ray) are used. Graf ultrasound classification is the gold standard for screening.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.