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Dr Marino Ortolani was an Italian pediatrician who developed a test for hip instability in the infant (1936) and then promoted early diagnosis of this condition to the medical community. He studied the pathoanatomy of hip instability in the 1940s. He wrote his textbook in 1948 and in 1952 he produced a movie about the examination and treatment of h...
Citations
... Taking this into consideration, the relevance of screening for DDH in regard to the potential socioeconomic burden is highlighted. Although clinical screening is widely recommended, there is no international consensus on hip ultrasound as a screening tool [17][18][19][20]. As reviewed by Kilsdonk et al., the lack of consensus leads to considerable variation in regard to screening programs across the world [17]. ...
Background: Graf ultrasound screening is considered an established method for early detection of developmental dysplasia of the hip (DDH). Although characterized by a high degree of standardization to allow for good reproducibility of results, examination-related factors may still affect sonographic measurements. The relative tilt angle between the hip and the probe is a potential pitfall as it significantly influences sonographic measurements and consequently classification of DDH according to Graf. Objectives: Evaluation of an electronic guidance system developed to reduce relative tilt angles and increase reliability and comparability in ultrasound screening of DDH. Materials and Methods: Twenty-five newborns were examined using a prototype guidance system, which tracks the position of the transducer and the pelvis to calculate the relative tilt angles. Two ultrasound images were obtained, one conventionally and the other one using the guidance system. Subsequently, relative roll and pitch angles and sonographic measurements were determined and analyzed. Results: The relative inclination angles in the conventional group ranged from −12.6° to 14.3° (frontal plane) and −23.8° to 32.5° (axial plane). vs. −3.7° to 3.0° and −3.2° to 4.5° in the guidance system group. The variances were significantly lower in the guidance system-assisted group for both planes (p < 0.001 and p < 0.001, respectively). The optimized transducer position showed significant effects and consequently significantly reduced alpha angles were observed (p = 0.001, and p = 0.003). Conclusions: The guidance system allowed a significant reduction in the relative tilt angles, supporting optimal positioning of the transducer, resulting in significant effects on Graf sonographic measurements. This technique shows great potential for enhancing the reproducibility and reliability of ultrasound screening for DDH.
... Ortolani method is the clinical test used to spot unstable hips whereby the dislocated femoral head is relocated by a sudden palpable clunk into the acetabulum by holding the infant's hip although the accuracy is dependent on skills and experience of the operators [2], [5]. ...
Objectives: To show the vital role of dynamic ultrasound in hip instability screening and review the management plans available for DDH associated with instability with a view to reduce the incidence of complication from delayed diagnosis in our region. Place and Duration of the study: Helena governmental rehabilitation center for children with special needs, Erbil-Iraq, between Nov’21 to Jan’23. Material and Method: This study included 942 infants’ hips presenting with high-risk indicators or a positive clinical examination ranging in age from 6 weeks to 6 months. We performed the ultrasonography using the static Graf technique to determine the DDH Types and then apply the dynamic scan to find stability using Moren-Terjesen’s and Harcke methods. The management approaches were conducted considering both techniques. We used SPSS version 28 along with Chi-square test for data analysis and comparison of proportions. Results: In this retrospective cross-sectional study of 942 hips, the mean age of the infants was 11.9±4.8 weeks with male to female percentage of 46% to 54%. We found a correlation between family history and breech presentation to the dynamic scan stability. In the Graf technique 55% showed the absence of dysplasia while the dynamic scan showed 66% of the hips as normal and 34% as unstable. Further, the significant statistical association (P= 0.001) between the results of dynamic scan stability to the effect on the management plan was also found to advise the change for the unstable hips. Conclusion: It is crucial to apply both static and dynamic scans in the screening of DDH, so that we can reduce the possibility of late detection and elevate the level of diagnostic accuracy. We should follow a strict guideline for the management of all DDH cases (stable and unstable) and change the plan accordingly.
... [1][2][3] Ortolani's collection is a unique collection of post-mortem infant specimens that were dissected and evaluated by Ortolani, who evaluated them to identify the cause of the "jerk sign" or "segno dello scatto." 4 Ortolani and his son preserved the collection until it was donated to the Institute of Anatomy at the University of Padua in 2008. 5 This unique collection allowed the study of the anatomy of non-teratological infant hips with varying degrees of hip dysplasia. ...
Purpose
This study evaluated and quantified femoral anteversion and femoral head sphericity in healthy and dysplastic hips of post-mortem infant specimens from Ortolani’s collection.
Methods
Healthy hips and hips with cases of dysplasia, with a large variety of severity, were preserved. Morphological measurements were taken on 14 specimens (28 hips), with a mean age of 4.68 months. The degree of dysplasia was classified as mild (A) to severe (D); 11 hips were Grade A, 6 hips were Grade B, 7 hips were Grade C, and 4 hips were Grade D. The femoral anteversion angle, the minimum femoral head diameter, and the maximum femoral head diameter were measured. The minimum and maximum femoral head diameters were used to estimate femoral head sphericity.
Results
The mean femoral anteversion angle was 30.81 degrees ± 11.07 degrees in cases and 29.69 degrees ± 12.69 degrees in controls. There were no significant differences between the normal-to-mild group and moderate-to-severe group when comparing the femoral anteversion angle (p = 0.836). The mean estimated sphericity was 1.08 mm ± 0.50 mm in cases and 0.81 mm ± 0.65 mm in controls, with no statistically significant difference between the groups (p = 0.269).
Conclusion
Ortolani’s collection showed no significant differences between healthy and dysplastic hips in specimens under 1 year of age. While the femoral head appeared slightly more flattened in dysplastic hips, it was not statistically significant. The findings in the unique collection add to the knowledge of the pathoanatomy of infantile hip dysplasia.
Clinical Relevance
Femoral anteversion may not play a role in the etiology and pathogenesis of DDH.
... Abnormalities in physical examination include limited hip abduction, leg length discrepancy, and thigh or buttock fold asymmetry (2) . The most sensitive clinical test to detect hip instability is the Ortolani maneuver, in which abducting the infant's hip causes the dislocated femoral head to relocate into the acetabulum with a palpable clunk (20,21) . ...
... Moreover, it is easily treated when detected at an early stage. For over 80 years, screening based on clinical examination has been highly recommended (20,21) . Unfortunately, there is no international consensus concerning the application of ultrasound as a screening tool for DDH (34) . ...
Developmental dysplasia of the hip comprises a broad spectrum of abnormalities in hip development, of variable severity. Besides physical examination, ultrasound is the preferred imaging modality for screening for developmental dysplasia of the hip in children aged younger than six months. The Graf method is the most widely used ultrasound technique for infant hips; a stepwise approach will be shown in this article. Furthermore, the process of dynamic ultrasound imaging will be explained as well as the use of transinguinal ultrasound in infants wearing a spica cast. There is no consensus on the best way to screen for developmental dysplasia of the hip, which is probably the reason why different screening programs exist throughout Europe, as will be discussed in this article. The use of universal versus selective ultrasound remains a controversy, as does the timing. Is it better to perform sonography in all newborn infants like in Germany and Austria? Or should we examine only the infants with clinical hip instability or risk factors (breech position, positive family history), like in the UK and the Netherlands? This article reviews the epidemiology, static and dynamic ultrasound techniques in screening for developmental dysplasia of the hip, and differences in screening programs throughout Europe. Set aside the uncertainties about whom and when to screen, it needs to be emphasized that ultrasound screening for developmental dysplasia of the hip is important, since the disease is initially occult and easier to treat when identified early. In this way, the radiologist can aid in preventing serious disability of the hip.
Developmental dysplasia of the hip (DDH) is the most common congenital disease of the musculoskeletal system in newborns and encompasses a disease spectrum ranging from a stable hip with a mildly dysplastic acetabulum to complete hip dislocation. Systematic screening for infant DDH has been performed for several decades all over the world and has contributed greatly to the early detection, diagnosis and treatment of DDH. However, some cases of delayed diagnosis still occur among the screened population, or conversely, overdiagnosis or overtreatment occasionally occurs. Furthermore, screening strategies for DDH are still controversial. The aim of our study was to analyze the current literature on DDH screening, paying particular attention to DDH screening strategies and their effectiveness. We searched the DDH screening literature from 1958 to 2021 in MEDLINE and other databases using PubMed. In this study, we reviewed the history of DDH screening and the progress of screening strategies and discussed the controversies regarding clinical and ultrasound screening methods with particular emphasis on the current opinions. Given the existing scientific evidence and changes in newborn DDH screening practices, universal ultrasound screening seems to be the best option for preventing late-detected cases and can be recommended as a favorable prevention strategy.
Clinical examination remains a cornerstone in all branches of Medicine. In the case of DDH, even if a good ultrasound service is available, the skills of clinical examination should not be dispensed with. It is not a case of “either/or” as both ultrasound scanning and clinical examination are complementary.For those responsible for the management of babies with DDH, the various findings listed for the clinical tests in this chapter provide a valuable understanding of the pathology with which we are dealing. A good clinical examination takes only about 3 min, and while it is recognized that cases of DDH may be missed on clinical examination even in expert hands, nevertheless it is 3 min well spent.In addition, in systems that do not yet have universal ultrasound screening, clinical examination is critical. Even when universal ultrasound screening is in place, the quality of the scans, and the quality of their interpretation, can vary.For all these reasons, familiarity with the principles and practice of clinical examination is important. Such familiarity, however, needs training and practice, so training of responsible healthcare professionals in clinical examination remains a critical component of the overall effort to minimize the impact of this condition.KeywordsHipDevelopmental dysplasiaInstabilityClinical examination
The problem of Developmental Dysplasia of the Hip (DDH), a condition that was previously named as Congenital Dislocation of the Hip, has been recognized for a very long time.Clinical examination, traditionally considered as the main method for the diagnosis of the disorder, was initially supplemented with plain radiography, and then later, with ultrasound, a method suitable for the early detection of DDH.There is very encouraging evidence from countries that have established universal ultrasound screening, that this approach has impacted dramatically on the problem of DDH. However, for various reasons, we are still some distance from having worldwide agreement or uniformity on this issue. It was against this background that, in September 2018, a meeting was held in Csolyospalos, Hungary, with the aim of achieving consensus on the various topics related to the early detection and treatment of DDH.Arising from the meeting, the International Interdisciplinary Consensus Committee on DDH Evaluation (ICODE) was formalized, with an aim to work toward consensus on the various issues regarding DDH, to promote, standardize, and continually improve teaching and training in the Graf method of infant hip ultrasound and to use its international network to support research, audit, and quality improvement in the field of detection and early treatment of DDH.KeywordsInternational Interdisciplinary Consensus Committee on DDH EvaluationICODE
