# A 6-month-old infant is being evaluated for developmental dysplasia of the hip (DDH). The nurse is preparing to assist with the Ortolani test. Which nursing action is the MOST important safety consideration during this examination?

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> subject: Child Health

## 문제

A 6-month-old infant is being evaluated for developmental dysplasia of the hip (DDH). The nurse is preparing to assist with the Ortolani test. Which nursing action is the MOST important safety consideration during this examination?

## 보기

1. Position the infant in a prone position to better visualize hip alignment
2. Ensure gentle handling and avoid excessive force during hip manipulation **✔ 정답**
3. Apply firm pressure to stabilize the pelvis throughout the examination
4. Maintain the infant in a supine position with legs fully extended

**정답: 2**

## 해설

The Ortolani test requires gentle handling to avoid injury to the infant's developing hip joint. Other positions or excessive force can cause harm.

## 심화 해설

Understanding the Ortolani Test and Safety

The Ortolani test is a specific physical examination maneuver used to identify a dislocated but reducible hip in an infant with developmental dysplasia of the hip (DDH). The core of the procedure involves a gentle sequence of hip flexion, abduction, and anteriorly directed lifting. The study by Chow et al. explicitly investigated the forces and maneuvers involved in these neonatal hip tests because they are "often poorly performed," with the goal of defining a "standard of safe practice" [1]. The primary safety concern, therefore, is directly related to the technique and force applied by the examiner.

Why Option 2 is the Most Important Safety Consideration

Option 2, "Ensure gentle handling and avoid excessive force during hip manipulation," is correct because the foundational safety standard for the Ortolani test is the controlled and minimal application of force. The research aimed to measure the forces applied during the test to establish a safe standard, implying that excessive or uncontrolled force is a known risk [1]. Applying too much pressure can cause pain, microtrauma to the developing femoral head or acetabular labrum, or even iatrogenic injury. The test's diagnostic value relies on feeling the subtle "clunk" of the femoral head relocating over the acetabular rim, a sensation that is completely obscured by forceful handling. Gentle manipulation is not merely a comfort measure; it is the critical element that makes the test both safe and diagnostically accurate.

Analysis of Incorrect Options

- Option 1: Positioning the infant prone is incorrect. The Ortolani maneuver requires the infant to be supine on a firm, flat surface. A prone position makes the necessary hip flexion and abduction sequence impossible to perform and would not allow for assessment of hip reduction.

- Option 3: Applying firm pressure to stabilize the pelvis is a common error. While stabilizing the pelvis is necessary, it must be done with a gentle, steady hold, not firm pressure. The study’s focus on defining safe force parameters directly contradicts the idea of applying "firm pressure," which could transmit excessive force to the contralateral hip or spine and interfere with the subtle feel of the relocation [1]. The stabilization hand should simply prevent the pelvis from lifting off the examination surface.

- Option 4: Maintaining the infant supine with legs fully extended is the starting position for assessing limb length discrepancy (Galeazzi sign), not for performing the Ortolani test. The Ortolani test begins with the hips flexed to 90 degrees. Full extension would prevent the examiner from abducting the hip and lifting the greater trochanter, which is the essential mechanism for reducing a dislocated hip.References (research sources)

- [1]Measurement of the forces and movements involved in neonatal hip testing.Research articleChow YW, Turner I, Kernohan WG, Mollan RA. (1994) · DOI: 10.1016/1350-4533(94)90036-1

## 임상 시나리오

Ortolani Test: Safe Infant Hip ExaminationPreventing Injury During DDH Screening
The Ortolani test identifies a dislocated but reducible hip. Position the infant supine with the examiner's hand over the knee, thumb on the inner thigh and fingers on the greater trochanter.

The critical action is gentle, controlled manipulation. Flex the hip to 90 degrees, then smoothly abduct while lifting the greater trochanter anteriorly. A positive sign is a palpable "clunk" of reduction, not a high-pitched click.

CautionAvoid excessive or forceful pressure. Force can cause pain, microtrauma to the femoral head or acetabular labrum, and will obscure the subtle clunk, leading to a missed diagnosis.

## 핵심 개념

- **Ortolani test** — A maneuver to detect a dislocated but reducible hip in DDH by gently abducting the flexed hip and lifting the femoral head anteriorly.
- **Developmental Dysplasia of the Hip (DDH)** — A spectrum of abnormalities involving the developing hip joint, ranging from acetabular dysplasia to complete dislocation.
- **Hip clunk** — The palpable and sometimes audible sensation of the femoral head relocating over the acetabular rim during the Ortolani test.
- **Iatrogenic injury** — Harm caused inadvertently by medical examination or treatment, such as microtrauma from excessive force during hip manipulation.
- **Acetabular labrum** — A fibrocartilaginous rim around the acetabulum that deepens the socket; vulnerable to injury from forceful reduction maneuvers.

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