Paediatric orthopaedics: negative Ortolani in a late-presenting hip: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

Orthopaedics · Paediatric orthopaedics: negative Ortolani in a late-presenting hip

Sample item

A 7-month-old girl has asymmetrical thigh creases, a short left thigh with knees flexed and limited left hip abduction. Ortolani and Barlow tests are negative on the left. How is this explained?

ABoth tests exclude dislocation at any ageBThe dislocation is now fixed and will not reduce on manoeuvreCThe tests detect only subluxation, never dislocationDLigamentous laxity has resolved and the hip is normal

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. The dislocation is now fixed and will not reduce on manoeuvre

Ortolani and Barlow tests rely on a reducible or unstable hip, which is true only in the newborn period. Over the following weeks adductor contracture and soft tissue changes fix the dislocation so the manoeuvres become negative, and limited abduction, asymmetry and a positive Galeazzi sign become the key findings, confirmed by ultrasound or radiograph.

Option by option

A. Both tests exclude dislocation at any age
A negative test cannot exclude DDH once the hip is fixed.
B. The dislocation is now fixed and will not reduce on manoeuvre (correct)
Correct. A fixed dislocation is irreducible, so the manoeuvres no longer give a clunk.
C. The tests detect only subluxation, never dislocation
The tests are designed to detect dislocatable and dislocated hips.
D. Ligamentous laxity has resolved and the hip is normal
Limited abduction and short thigh argue against a normal hip.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is B, The dislocation is now fixed and will not reduce on manoeuvre. Ortolani and Barlow tests rely on a reducible or unstable hip, which is true only in the newborn period.

Why is "Both tests exclude dislocation at any age" not the answer?

A negative test cannot exclude DDH once the hip is fixed.

Why is "The tests detect only subluxation, never dislocation" not the answer?

The tests are designed to detect dislocatable and dislocated hips.

Why is "Ligamentous laxity has resolved and the hip is normal" not the answer?

Limited abduction and short thigh argue against a normal hip.

What concept does this question test?

It tests Paediatric orthopaedics: negative Ortolani in a late-presenting hip in Orthopaedics. Over the following weeks adductor contracture and soft tissue changes fix the dislocation so the manoeuvres become negative, and limited abduction, asymmetry and a positive Galeazzi sign become the key findings, confirmed by ultrasound or radiograph.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric orthopaedics: negative Ortolani in a late-presenting hip?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.