Ortolani’s maneuver is one of the clinical tests performed to the newborn in the first hours of life and has the function of identifying early the presence of even dislocated, or preved, but reducible.
There Ortolani maneuver It is one of the clinical tests performed to the newborn in the first hours of life and has the function of identifying early the presence of even dislocated, or preved, but reducible.
Ortolani’s test is important because the hip dysplasia In Italy, and in particular in the most northern areas, it can affect up to 30 children per 1000 born and can also be present in the absence of risk factors. During intrauterine development, in fact, it is possible that the head of the femur if it does not find stability in its anatomical accommodation tends to leave and deform.
The maneuver, for its simplicity of execution and the absence of costs, represents today, one of the tests performed as an exam of screening To all infants in order to identify early pathological neonatal even. Let’s see how this test is carried out and what to do in the event of a positive or negative outcome to the Ortolani maneuver.
What is Ortolani’s maneuver?
There anchor evolutionary dysplasia It represents the most common skeletal congenital pathology in the newborn with an important variability depending on the geographical location. In Italy, and in particular in the most northern areas (with a greater impact in Emilia-Romagna and Brianza), it can affect up to an incidence of 30 children per 1000 born And it can also be present in the absence of risk factors.
During intrauterine development, it can take place, in fact, that the bottom and edge of the cotile (a bone collecting) do not develop in a physiological way and therefore do not completely contain the head of the femur, not finding stability in its anatomical accommodation, will tend to move and deform. There are gods Facal factors full -bodied for the development of hip dysplasia as:
- the female sex, with a risk greater than 5 times than the male one;
- the running position during intrauterine life;
- The twin and all those conditions in which the intrauterine space is reduced (uterine malformations, reduction of amniotic liquid and so on).
By congenital pre-illegal illusion, the diagnosis is intuited and placed by Ortolani, we mean a condition, already present at birth, in which the head of the femur is losing relationship with the anatomical cavity that contains it (acetabulum or cotile). When it comes to congenital dislocation of the hip It refers to a condition in which the head of the femur has no relationship with its cotile. There is talk of, however, of hip dysplasia When the joint relationship is maintained but the anatomical morphology of the cotile, and consequently of the head of the femur, are altered.
What is Ortolani’s maneuver? There Ortolani maneuver It is one of the clinical tests performed at newborn In the first hours of life, which is recommended to repeat at any health budget in the first 6 months of life. What is the Ortolani test for? The test has the function of identifying early presence of also dislocatedor prelustedbut reducible.
The origin of the maneuver is due to the Pediatrician Ortolani, who lived in the early twentieth century that one day attentive the words of a mother in describing one snap sensation While he changed the diaper to one of his twins. At that point he actually verified the presence of an articulated “shot” and, comparing it with a radiographic examination, diagnosed a “congenital pre-anchor pre-unusage”.
The maneuver, for its simplicity of execution and the absence of costs, represents today, one of the tests performed as Neonatal screening exam In order to identify early pathological neonatals early.
Ortolani maneuver: when practicing and how?
At this point we could ask ourselves: how is Ortolani’s maneuver practiced? There Ortolani maneuver It is carried out with the boys or the girl in a supine position with even 90 degrees. The examiner, placed in front of the boy or the girl, grabs the knees of the newborn with his own hands, placing his thumb on the inner side of the thigh and the middle finger sideways on the great trochanter.
From this starting position, a slight traction and progressive abduction is then performed in a controlled way and external rotation of the hip that is being examined until it reaches, if allowed, the plan on which the boy or girl is supported. Each hip is examined individually while the contralateral hip is maintained far to keep the pelvis stable.
In a physiological hip It is allowed to perform the movement of the Ortolani test in a fluid way. In cases where the hip is instead located, i.e. the head of the femur is outside its natural location, or partially dislocated, lOrtolani’s maneuver generates a characteristic “shot” That is, a tactile (and sometimes sound) feeling that can be felt from the medium -finished finger on the body of the boy or girl. The joint shot It derives from the repositioning of the femoral head within its headquarters.
Positive or negative ortolani: what does it mean?
In case of Positive ortolanior when the maneuver just described generates the characteristic joint sound, it is essential to perform early, before the hospital resignation, an ultrasound examination of the neonatal hips in order to evaluate the overall morphology of the hipsthe centering, or any decentralization, of the femoral head compared to the cotile and also its stability. For this reason, the newborn is sent to execute pediatric orthopedics advice.
The ortholani maneuver the orthopedist pediatrician then associates a accurate target examination in which it observes:
- the presence of any asymmetries of the inguinal and buttocks of the skin and buttocks;
- the evaluation of the overall articular mobility;
- The Galeazzi signin which the child is placed in a supine position with also and knees flexed at right angle e The height of the knees is observedif one of the two is shorter would suggest a dislocation of the hip on the side of the shortening of the femur;
- there Barlow maneuver In which starting from the same position as Ortolani’s maneuver, an opposite movement is made therefore starting from a maximum opening of the thighs (abduction) is carried out a controlled maneuver a slight traction and a progressive adduction In this case, a further snap feeling due in this case to an escape of the femoral head compared to the cotile could be felt.
What does negative ortolani mean? The test of Negative ortolanithat is, the absence of joint sounds, almost always excludes the presence of also preved or dislocated but reducible. Unfortunately it is not able to identify the also affected by dysplasic forms, as mentioned, and also with an altered morphological aspect.
To date, unfortunately, the dysplasia of the hip represents even the first cause of early secondary arthrosis of the hips and consequently the first cause of prosthetic replacement of the hip in the young adult.
For this reason in 2019 the three scientific societies affected by the problem (Italian society of pediatrics, medical radiology and pediatric orthopedics) have drawn up joint recommendations in order to trace the best way to go and minimize the possibility of escaping a diagnosis of hip dysplasia. To date, there is only talk of recommendations and not compulsory screening, but the exam is generally executable with totally free SSN or with tickets. In many hospital facilities it is already prescribed to discharge.
The recommendationsin summary, predict that:
- all infants, regardless of sex and associated risk factors they must be subjected to a clinical examination of hips at birthin the case of positive ortolani, must be subjected to early ultrasound examination or before discharge;
- all infants, even regardless of endangered risk factors for the development of dysplasic forms, must carry out An ultrasound examination of the hips between the fourth and sixth week of life by certified operators.
The ultrasound examination of the hips is therefore to be considered the Gold Standard exam in the early identification of the dysplasic forms, it should always be performed and by certified operators capable of correctly acquiring the images and a correct taking care of the patient should also be identified for all situations in which the ultrasound examination is positive.
