Measurement of the forces and movements involved in neonatal hip testing.
The screening for Developmental Dysplasia of the Hip in infants relies on the two manipulative tests developed by Ortolani and Barlow which are often poorly performed. This study investigated the forces applied and the sequences of physical manoeuvres underlying the tests in order to define a standard of safe practice. Eight subjects examined the hips of two training models that closely simulated the behaviour of a range of infant hip pathologies. The forces applied and the manoeuvres employed during each examination were recorded using a purpose-built force and displacement transducer system. The analysis concentrated on the peak forces and the biomechanical conditions necessary to detect an abnormality. The models' legs had to be abducted beyond certain critical angles in order to dislocate and relocate an unstable femoral head and the magnitude of the force required to dislocate the femoral head was significantly less than the peak force applied (12 N vs 33 N, p < 0.001). Also, the Palmen test, a less well known technique, provided the same level of diagnostic performance as the Barlow test but with a lower peak applied force (28 N vs 47 N, p < 0.001). Changes are therefore necessary to the training programmes for medical staff to ensure that the range of abduction during the manoeuvres is large enough to encompass the likely range of critical angles and that the forces applied are just sufficient so as not to overstress the joints.
Chow
Y W
YW
Queen's University of Belfast, Department of Orthopaedic Surgery, Musgrave Park Hospital, Northern Ireland, UK.
Turner
I
I
Kernohan
W G
WG
Mollan
R A
RA
D001696:Biomechanical Phenomena; D006618:Hip Dislocation, Congenital / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D008349:Manipulation, Orthopedic / Q000379:methods*; D008953:Models, Anatomic; D016059:Range of Motion, Articular; D012449:Safety