An ambulatory 16-month-old with a limp; which assessment finding indicates developmental dysplasia of the hip?

An ambulatory 16-month-old with a limp; which assessment finding indicates developmental dysplasia of the hip?

• A. Ortolani's maneuver
• B. Barlow's maneuver
• C. Adam's position
• D. Trendelenburg's sign

Answer: (D)

In a toddler with a limp, a Trendelenburg sign points to hip abductor weakness from a hip that isn’t stable, as seen in developmental dysplasia of the hip. When the child stands on one leg, the gluteus medius and minimus on the stance side must contract to keep the pelvis level. If the hip is dysplastic or dislocated, those abductors can’t stabilize the pelvis, so the pelvis drops on the opposite side. That sag or pelvic drop during single-leg stance is the positive Trendelenburg sign, a practical clue to DDH in an ambulatory child around this age. Ortolani and Barlow maneuvers are neonatal screening tests used to detect dislocation in infants, not typically used to diagnose DDH in a 16-month-old who is walking. Adam’s forward bend tests for scoliosis, not hip stability. So the pelvis-leveling finding during single-leg stance best fits the presentation of DDH in this scenario.

In a toddler with a limp, a Trendelenburg sign points to hip abductor weakness from a hip that isn’t stable, as seen in developmental dysplasia of the hip. When the child stands on one leg, the gluteus medius and minimus on the stance side must contract to keep the pelvis level. If the hip is dysplastic or dislocated, those abductors can’t stabilize the pelvis, so the pelvis drops on the opposite side. That sag or pelvic drop during single-leg stance is the positive Trendelenburg sign, a practical clue to DDH in an ambulatory child around this age.

Ortolani and Barlow maneuvers are neonatal screening tests used to detect dislocation in infants, not typically used to diagnose DDH in a 16-month-old who is walking. Adam’s forward bend tests for scoliosis, not hip stability. So the pelvis-leveling finding during single-leg stance best fits the presentation of DDH in this scenario.