## Clinical Examination vs. Imaging in DDH **Key Point:** While asymmetry of gluteal folds and limited hip abduction are suggestive signs, they are NOT present in all cases of DDH — particularly in mild dysplasia or unilateral cases where comparison may be subtle. These signs lack sensitivity and specificity. ### Barlow and Ortolani Tests **High-Yield:** - **Barlow test**: Hip in flexion and adduction; positive = posterior dislocation (hip slides out) - **Ortolani test**: Hip in flexion and abduction with gentle anterior pressure; positive = clunk as dislocated hip reduces - Both tests are most reliable in infants < 3 months of age ### Imaging Hierarchy | Age Group | Investigation | Rationale | | --- | --- | --- | | < 6 months | Ultrasonography (Graf) | Cartilaginous femoral head; no radiation | | > 6 months | Plain radiography (AP pelvis) | Ossification allows radiographic visualization | | Any age | MRI | Reserved for complex cases or pre-operative planning | **Clinical Pearl:** A clinically normal infant with a positive family history or breech presentation should still undergo ultrasound screening, even without physical examination findings. **Warning:** Asymmetric gluteal folds alone are NOT diagnostic — they may be present in normal infants and absent in DDH. Over-reliance on this sign leads to both false positives and false negatives. ### Why Option 3 is Incorrect The statement claims these signs are "present in all cases" — this is false. Many infants with DDH (especially mild dysplasia) have normal gluteal folds and may have only subtle limitation of abduction. Conversely, asymmetric folds can occur in normal infants. These are screening clues, not diagnostic criteria.
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