Basic Assessment Techniques for Hip Dislocation in the Pediatric Population Basic Assessment Techniques for Hip Dislocation in the Pediatric Population

Introduction

Hip dislocation is a common physiological problem in the pediatrics since it develops mostly during the gestation period due to the movement of the fetus in the womb. The problem is rife among children under the age of two years, but it can easily be diagnosed through physical examination at this stage (Byrd, 2012). The practitioners will often ask the parents specific questions to determine the degree of dislocation. Some of the questions include: Does the child feel pain while walking?. Did you encounter any complications during delivery?. and: Does the child find difficulty while walking or standing? There are three main techniques for assessing whether a child is suffering from this complication. They include Ortolani test, Barrow maneuver, and Galeazzi’s test. Hip dislocation is a prevalent physiological problem in the pediatrics, which can develop before, during or after birth, but it can be diagnosed through the Ortolani test, Barrow maneuver, and Galeazzi’s test.

Assessment of Hip Dislocation

Ortolani Test

The Ortolani test is performed by the medical examiner placing his/her hands over the child’s knees with the thumbs on the medial thigh while the rest of the fingers apply some slight pressure on the trochanter area as well as the lateral thigh. With slow abductions being performed on these areas, the dislocated hip will often reduce with a palpable “cluck.” The intensity of instability of the hip is categorized into two depending on the results of the examination. Positive Ortolani is a situation where the hip is dislocated and reducible at the same time. Negative Ortolani implies the hip of the child is dislocated, but it is irreducible (Byrd, 2012).

Barrow Maneuver

Barrow maneuver involves the examiner guiding the child’s hip into a kind of abduction movement by applying some mild force with his/her thumbs. In the event that the bones of the child are not stable, the femoral bone will slide over the rear rim of the acetabulum bone while producing some noticeable sensation of subluxation or dislocation. Relatively, the degree of instability is measured by the results of the test. If a dislocation is evident, then the test can be said to be positive Barrow, but if the hip is characterized by mild instability, that can be termed as a subluxation or rather a negative Barrow test (Godley, 2013).

Galeazzi’s Test

In this case, the child to be examined is made to assume a supine position while his/her legs are bent at ninety degrees with the feet being kept flat over a level surface. The practitioner will examine the child to ascertain any differences between the two knees. If one knee tends to be lower than the other, this is an indication of a dislocation in the lower side of one hip (Byrd, 2012).

It is advisable that new-born babies should be examined through physical techniques rather than using radiographic methods that can affect them. In the event that an examination indicates a positive hip dislocation, the child should be referred to an orthopedic for specialized attention (Byrd, 2012). However, in the case of children aged two years and above, ultrasonography has been found to be the most efficient technique for determining any traces of hip dislocation since the bones around the area have matured and differentiated, making it possible to carry out a medical examination. In children between the ages of 2 and 3 years, Ortolani and Barrow’s maneuver are often less sensible because unilateral dysplasia is present in an asymmetrical manner on the side of the dislocated hip, and thus the legs of the affected children will often turn outside, leaving some gap between the legs. In walking children aged three years and above unilateral dislocation results in the dislocated hip having a shorter leg than the other (Fleisher & Ludwig, 2010).

References

Byrd, J. W. T. (2012). Operative hip arthroscopy. Heidelberg: Springer. Retrieved from http://www.worldcat.org/title/operative-hip-arthroscopy/oclc/811139639/viewport.

Fleisher, G. R., & Ludwig, S. (2010). Textbook of pediatric emergency medicine. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health. Retrieved from http://www.worldcat.org/title/textbook-of-pediatric-emergency medicine/oclc/502393128/viewport.

Godley, D. R. (2013). Assessment, diagnosis, and treatment of developmental dysplasia of the hip. Journal of the American Academy of Physician Assistants, 26(3), 54–58. Retrieved from http://journals.lww.com/jaapa/Abstract/2013/03000/Assessment,_diagnosis,_and_treatment_of.11.aspx.