Pediatric Orthopedic Physical Examination of the Infant: A 5-Minute Assessment

Abraham Ganel, MD, Israel Dudkiewicz, MD, Dennis P. Grogan, MD


J Pediatr Health Care. 2003;17(1) 

In This Article


The hip joint should be assessed when the diaper is removed. The Ortolani and Barlow signs, which are provocative dislocation and relocation of a dislocated hip, are used to evaluate for developmental dysplasia of the hip. Pistoning is the feeling of the femoral head sliding out of the acetabulum and into the abductor musculature. Leg length discrepancy can be indicative of a number of abnormalities, including proximal femoral focal deficiency, pelvic obliquity, dysplasia/hypoplasia of the tibia or fibula, as well as hypoplasia of the entire leg. In order to assess leg length discrepancy, the child should be lying flat and straight with the hip and the knee joints extended. The soft tissues at the heels, as well as the height of the medial malleoli, should be compared. Asymmetrical thigh folds can be noted, but are not highly correlated with hip abnormality. Flexion/extension, abduction/adduction, and internal and external rotation of the hip should be assessed.


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