Which test is associated with an audible click or clunk when the clinician abducts an infant's hips with the hips and knees flexed?

• A. A positive Clarke's sign
• B. A negative tripod sign
• C. A negative Barlow test
• D. A positive Ortolani test

Answer: (D)

This question hinges on recognizing the maneuver used to detect developmental dysplasia of the hip by relocating a dislocated femoral head into the acetabulum. When you perform this maneuver, you start with the infant lying supine, hips and knees flexed to about 90 degrees, and then gently abduct the hips. If a hip is dislocated, the femoral head can be guided back into its socket, producing a distinct palpable and often audible “clunk” as it relocates. That clunk is the hallmark sign of a positive relocation test.

The other test described in this context is used to identify instability by attempting to dislocate a hip that may be predisposed to dislocation, rather than to relocate one. It involves adduction and gentle posterior pressure rather than abduction, and it does not produce the relocation clunk when the hip is abducted.

So the test described, producing an audible click or clunk during abduction with hips and knees flexed, is the one that detects hip relocation into the acetabulum.