Congenital Dislocation of the Hips

Abstract

The Ortolani sign is best described as the feeling elicited by the examiner as the femoral head slides out of the center of the acetabulum when the flexed thigh is adducted and pushed posteriorly while the proximal femur is pushed laterally. The sign is also felt when the femoral head returns to the center of the socket when the thigh is pulled and abducted. The feeling is a "jolt" and not a "click."The latter is felt in many normal newborn hips due to a relaxed joint capsule and is a sign of the neonatal unstable hip which becomes spontaneously stable within several weeks regardless of the form of treatment given (if any). Several prospective studies have shown that no harm comes from ignoring "clicks" and treating only those patients with a truly positive Ortolani sign (a "jolt") which is found in less than 1% of all neonates. However, there are some infants who have frank dislocation that is discovered later in infancy. Some of these infants have not been previously examined; some have had a negative Ortolani sign in the neonatal period, probably because the hip is already dislocated and not reducible.