Galeazzi Maneuver: Purpose, Procedure, Interpretation, and Limitations

What is the Galeazzi Maneuver?

The Galeazzi maneuver, also known as the Allis Sign, is a clinical assessment primarily used in infants to detect developmental dysplasia of the hip (DDH) by identifying a unilateral limb length discrepancy.

Understanding the Galeazzi Maneuver

The Galeazzi maneuver is a simple yet crucial component of the physical examination for infants, specifically aimed at screening for developmental dysplasia of the hip (DDH). DDH is a condition where the hip joint has not formed properly, ranging from mild instability to complete dislocation of the femoral head from the acetabulum. Early identification of DDH is paramount, as timely intervention can prevent long-term complications such as chronic pain, gait abnormalities, and degenerative arthritis.

While the maneuver itself is straightforward, its interpretation requires an understanding of basic anatomy and the potential implications of a positive finding. It is typically performed as part of a comprehensive hip examination, which may also include the Ortolani and Barlow maneuvers.

Purpose and Clinical Significance

The primary purpose of the Galeazzi maneuver is to detect significant unilateral hip dislocation or subluxation in infants. A dislocated hip can cause the femur (thigh bone) on the affected side to appear shorter when the infant's hips and knees are flexed. This apparent shortening is due to the femoral head not being properly seated within the acetabulum, altering the alignment of the limb.

Its clinical significance lies in its role as an early screening tool. A positive Galeazzi sign prompts further diagnostic investigation, typically with hip ultrasound in infants younger than 4-6 months, or X-rays in older infants, to confirm the diagnosis and guide appropriate treatment.

How the Galeazzi Maneuver is Performed

The procedure for performing the Galeazzi maneuver is as follows:

• Patient Positioning: The infant is placed supine (lying on their back) on a firm, flat surface.
• Hip and Knee Flexion: The examiner gently flexes both of the infant's hips to 90 degrees, ensuring the knees are also flexed.
• Foot Placement: The infant's feet are then placed flat on the examining table or surface, ensuring the heels are aligned next to each other.
• Observation: The examiner carefully observes the height of the infant's knees.

The key to an accurate assessment is to ensure that the infant is relaxed and that both hips are flexed equally, with the feet perfectly aligned. Any tension or asymmetrical positioning can lead to inaccurate results.

Interpreting the Results

The interpretation of the Galeazzi maneuver is based on the comparative height of the knees:

• Positive Galeazzi Sign: If one knee appears significantly lower than the other, it indicates a positive Galeazzi sign. This suggests that the femur on the side of the lower knee is relatively shorter, most commonly due to a dislocated or severely subluxated hip. The apparent shortening is not due to a true bone length difference but rather the altered position of the femoral head.
• Negative Galeazzi Sign: If both knees are at the same height, the Galeazzi maneuver is considered negative. This indicates no significant limb length discrepancy detectable by this specific maneuver. However, a negative sign does not definitively rule out DDH, especially if other clinical signs or risk factors are present.

Limitations and Considerations

While valuable, the Galeazzi maneuver has certain limitations:

• Unilateral Dislocations: It is most effective in detecting unilateral hip dislocations. If both hips are dislocated, both knees may appear equally low, leading to a false negative result because there is no asymmetry to observe.
• Age Sensitivity: The maneuver is most reliable in infants up to 3 months of age. As infants grow older, muscle contractures around a dislocated hip can make it more difficult to fully flex the hip and knee, potentially obscuring the limb length discrepancy.
• Not Diagnostic: The Galeazzi maneuver is a screening tool, not a diagnostic one. A positive finding warrants further imaging studies (ultrasound or X-ray) to confirm the diagnosis of DDH and assess its severity.
• Other Causes: While DDH is the primary concern in infants, other rare conditions could potentially cause a limb length discrepancy, although this is less common.

Who Performs the Galeazzi Maneuver?

The Galeazzi maneuver is a standard part of the routine physical examination performed by various healthcare professionals involved in infant care, including:

• Pediatricians
• Neonatologists
• Family Physicians
• Orthopedic Surgeons
• Nurses

These professionals are trained to identify the subtle signs of DDH and ensure that infants receive appropriate follow-up care.

Conclusion

The Galeazzi maneuver stands as an important, non-invasive screening tool in the early detection of developmental dysplasia of the hip in infants. By identifying an apparent limb length discrepancy, it serves as a critical indicator prompting further diagnostic evaluation. While its simplicity belies its importance, it is crucial to remember its limitations and to interpret findings within the context of a comprehensive clinical examination. Early diagnosis and intervention for DDH, often initiated by a positive Galeazzi sign, are key to ensuring optimal long-term outcomes for affected children.