A 6-week-old is suspected of having developmental dysplasia of the hip. Which test would best assess this?

• A. Barlow and Ortolani
• B. Galeazzi and Klisic
• C. Trendelenburg pelvic tilt test
• D. Romberg balance test

Answer: (A)

In a 6-week-old, diagnosing developmental dysplasia of the hip relies on maneuvers that test hip stability directly. The best tools are the Barlow and Ortolani exams. Barlow begins with the hip flexed and adducted, applying gentle posterior pressure to see if the femoral head can be displaced posteriorly out of the acetabulum; a positive result indicates an unstable or dislocatable hip. Ortolani then evaluates reduction: with the hip flexed and abducted, gentle anterior pressure is used to relocate a dislocated hip, and a palpable “clunk” as the head slips back into the acetabulum confirms instability but now corrects with reduction. These tests are designed specifically for newborns and young infants because they detect dislocation or instability before the socket fully forms.

Galeazzi testing looks for leg length discrepancy when the hips and knees are flexed, which can suggest hip problems but is not as direct or sensitive for early DDH in a 6-week-old. The Trendelenburg pelvic tilt and Romberg balance tests assess gait and balance in older children or adults, not appropriate for evaluating hip stability in a newborn.