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ULY CLINIC
ULY CLINIC
24 Septemba 2025, 13:40:48
Galeazzi’s sign
Galeazzi’s sign refers to unequal knee heights observed when an infant’s hips and knees are flexed at 90°, indicating apparent shortening of the femur on the affected side. This sign is a hallmark of unilateral congenital hip dislocation (developmental dysplasia of the hip, DDH).
Pathophysiology
In DDH, the femoral head is displaced from the acetabulum, leading to apparent femoral shortening.
Loss of normal articulation results in the affected knee appearing lower when hips and knees are flexed simultaneously.
This sign reflects structural abnormality of the hip joint rather than generalized limb shortening.
Examination Technique
Patient positioning: Place the infant supine on a firm, flat surface.
Hip and knee flexion: Flex both hips and knees to 90°, keeping the feet aligned on the surface.
Observation: Compare the heights of both knees.
A lower knee indicates the affected side.
Documentation: Record the side, degree of asymmetry, and any associated findings.
Clinical Features
Feature | Manifestation |
Knee height | One knee lower than the other (apparent femoral shortening) |
Hip mobility | Limited abduction on the affected side |
Leg length | Apparent shortening of femur on affected side |
Associated findings | May accompany positive Ortolani or Barlow maneuvers |
Differential Diagnosis
Condition | Key Feature | Notes |
Developmental dysplasia of hip | Positive Galeazzi sign + limited hip abduction | Most common cause in infants |
Leg length discrepancy | Unequal leg lengths not due to hip displacement | Can be congenital or acquired |
Femoral fracture | Shortening and tenderness | Usually traumatic, with pain and swelling |
Hip joint infection/arthritis | Shortening with pain and local inflammation | Rare in neonates |
Pediatric considerations
Best assessed in infants younger than 12 months, before walking age.
Often used alongside Ortolani and Barlow maneuvers for DDH screening.
Early detection allows non-surgical interventions, such as Pavlik harness, to be effective.
Geriatric considerations
Rarely applicable in adults.
Apparent shortening may indicate fracture, hip dislocation, or degenerative joint disease.
Limitations
Bilateral hip dislocation may produce false-negative results, as both knees may appear equal.
Mild or partial dislocations may not produce noticeable asymmetry.
Should always be interpreted in conjunction with other hip screening maneuvers and imaging.
Patient/Caregiver counseling
Explain that unequal knee height may reflect a hip problem (DDH).
Emphasize the importance of early evaluation and treatment to prevent long-term complications.
Discuss possible orthopedic referral for imaging and management.
Conclusion
Galeazzi’s sign is a reliable screening tool for unilateral congenital hip dislocation in infants. Careful examination, combined with other maneuvers and imaging, enables early diagnosis and treatment, improving long-term hip stability and function.
References
Bialik V, Bialik GM, Blazer S, Sujov P, Wiener F, Berant M. Developmental dysplasia of the hip: A new approach to incidence. Pediatrics. 1999;103(1):93–99.
American Academy of Pediatrics. Clinical practice guideline: Early detection of developmental dysplasia of the hip. Pediatrics. 2000;105(4):896–905.
Tachdjian MO. Tachdjian’s Pediatric Orthopaedics. 6th ed. Philadelphia: Elsevier; 2021.
Weinstein SL, Flynn JM. Lovell and Winter’s Pediatric Orthopaedics. 8th ed. Philadelphia: Wolters Kluwer; 2020.