Graf Method Research Articles

Diagnostic Accuracy of Ultrasonography Method of Graf in the detection of Developmental Dysplasia of the Hip: A Meta-Analysis and Systematic Review.

The present study aimed to perform a meta-analysis on the performance of Graf's ultrasonography method in the detection of developmental dysplasia of the hip (DDH). A query was conducted on electronic bibliographic databases until the end of October 2020. The inclusion criteria entailed: 1. the use of Graf method in less than 12 weeks of age, 2. the use of follow-up as reference test, and 3. provision of crude data. Pooled diagnostic performance measures were calculated. Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) checklist was utilized to assess the quality of the included studies. The hierarchical summary receiver-operating characteristic (HROC) curves were also drawn. Six articles (including seven populations, 11,012 patients) were considered eligible. The pooled sensitivity and specificity were obtained at 93% (95% CI: 0.57-0.99) and 97% (95% CI:0.86-0.99), respectively (area under curve= 0.99). The pooled positive and negative likelihood ratio, as well as diagnostic odds ratio, was reported as 28.4, 0.07, and 396, respectively. As evidenced by the obtained results, Graf's method is a useful ultrasonography technique with acceptable accuracy for screening DDH in neonates. However, there are uncertainties about the best population and age for screening. Furthermore, more attention should be paid to the proper training of this method to reduce the number of operator errors.

The feasibility of ultrasound Graf method in screening infants and young children with congenital hip dysplasia and follow-up of treatment effect.

BackgroundCongenital hip dysplasia is a common limb deformity in infants and young children. This study aimed to clarify the feasibility of ultrasound Graf method in screening congenital hip dysplasia of infants and young children, and its application value in follow-up treatment.MethodsA total of 1,313 infants and young children with clinically suspected congenital hip dysplasia in our hospital from December 2016 to January 2018 were selected as the participants and were examined by ultrasound Graf method. The acetabulum shape and the measured values of α and β angles of the participants were observed. The development of the hip joint and distribution of congenital hip dysplasia were analyzed, and the treatment effect was followed up.ResultsAmong 1,313 infants and young children with suspected congenital hip dysplasia, the positive rate of congenital hip dysplasia was 6.02% (79/1,313). The lesions were located on both sides in 14 cases, on the left side in 67 cases, and on the right side in 26 cases. The α angle of cases with congenital hip dysplasia was significantly lower than that of normal cases, and the β angle was significantly higher than that of normal cases (P<0.05). Ultrasound follow-up results showed that out of 24 cases who underwent hip abduction exercises, 22 (91.67%) returned to normal, and the remaining 2 returned to normal after Pavlik sling treatment. Among 46 cases treated with Pavlik sling, 42 (91.30%) returned to normal, and the remaining 4 cases returned to normal after closed reduction and plaster fixation. A total of 9 participants underwent plaster fixation after closed reduction, all of which returned to normal.ConclusionsUltrasound Graf method can be used as the first choice for screening infants and young children with congenital hip dysplasia. It can be followed up to observe the clinical treatment effect, and it has high clinical application value.

Using Z-score to optimize population-specific DDH screening: a retrospective study in Hangzhou, China

BackgroundDDH (Developmental Dysplasia of the Hip) screening can potentially avert many morbidities and reduce costs. The debate about universal vs. selective DDH ultrasonography screening in different countries revolves to a large extent around effectiveness, cost, and the possibility of overdiagnosis and overtreatment. In this study, we proposed and evaluated a Z-score enhanced Graf method to optimize population-specific DDH screening.MethodsA total of 39,710 history ultrasonography hip examinations were collected to establish a sex, side specific and age-based Z-scores model using the local regression method. The correlation between Z-scores and classic Graf types was analyzed. Four thousand two hundred twenty-nine cases with follow-up ultrasonographic examinations and 5284 cases with follow-up X-ray examinations were used to evaluate the false positive rate of the first examination based on the subsequent examinations. The results using classic Graf types and the Z-score enhanced types were compared.ResultsThe Z-score enhanced Graf types were highly correlated with the classic Graf’s classification (R = 0.67, p < 0.001). Using the Z-scores ≥2 as a threshold could reduce by 86.56 and 80.44% the false positives in the left and right hips based on the follow-up ultrasonographic examinations, and reduce by 78.99% false-positive cases based on the follow-up X-ray examinations, respectively.ConclusionsUsing an age, sex and side specific Z-scores enhanced Graf’s method can better control the false positive rate in DDH screening among different populations.

Paediatric hip ultrasound: uncertainties in examination and choice of treatment.

PurposeIn Germany, neonates undergo hip sonography examination using the Graf method during the routine U3 screening examination, performed by consultant physicians four to five weeks after birth, and are referred to specialized orthopaedic departments if there are any uncertainties. This study evaluated the quality of sonographic screening in the outpatient sector and the treatment requirements of referred children. MethodsWe performed a retrospective analysis of the patient data of 384 neonates collected in consultations performed between April 2016 and April 2019. ResultsIn total, 74% (n = 284) of neonates presented a hip type Ia/b. Treatment (abduction brace or Fettweis cast) was required in 32% (n = 122) of cases. The treatment duration was significantly correlated with age at first presentation (Pearson’s r = 0.678; p = 0.001). The treatment duration for patients aged > 200 days old at first presentation was twice as long as those aged 100 days at first presentation. Patients with public health insurance require referral by a consultant. Developmental dysplasia of the hip as referral diagnosis could not be confirmed in control examination in 64% (n = 132) of cases. Of the public health insured children, 97% (n = 200) were referred through a consultant paediatrician. ConclusionWe identified deficits in performing and interpreting the Graf method of ultrasound examination. A total of 64% of referred pathological hips turned out to be physiological configurations in our control examination. The future goal should be to increase anatomical knowledge of the newborn hip and ensure the correct use of Graf ultrasound method. Advanced training courses are recommended and necessary. Level of evidenceIV

Early neonatal universal ultrasound screening for developmental dysplasia of the hip: a single institution observational study.

We evaluated the effect of early universal ultrasound (US) screening program for developmental dysplasia of the hip (DDH). A total of 21,676 newborns between 2006 and 2015 were included in the study. All hips were examined by US within the first week of life. The incidence of sonographic hip-types according to the Graf method was analyzed, and then followed prospectively. Risk factors for DDH and treatment measures were also recorded, together with the number of first surgical procedures before the age of three years. Overall, 92.5% of hips were mature (Graf types Ia, Ib) at first examination, 7.2% were mature (Graf type IIa) and 0.3% were pathological (Graf types IIc to IV). A total of 146 pathological hips were detected in 118 of newborns (0.6%). Only 0.26% of screened population was treated with an orthosis. The rate of first surgical procedures and the rate of late detected DDH were 0.23 and 0.09 per 1000 live births, respectively. Regarding risk factors, positive family history, female gender, breech presentation, and high birth weight were significantly more common in newborns with pathological hips. Early neonatal universal US screening using Graf method is recommended to timely detect DDH and to provide the optimal conservative approach of management. It seems to be effective in reducing the overall treatment rate, together with the rate of surgical procedures and late detected cases.

ANALYSIS OF THE REFUNCTIONED MILLET HAMAM THROUGH SPACE SYNTAX

Space syntax is a model that has been developed based on spatial formation characteristics. The theory of space syntax indicates a strong relationship between spaces and social structures. The concept of space syntax in this study served as a basis for the assessment of the new function displayed by the architectural structure named “Millet Hamamı (Public Hammam)” in Afyonkarahisar, Turkey. The spatial use of another architectural structure named “Kültür ve Semt Evi (Local House of Culture)” that was transformed from Millet Hamamı was analyzed in this study. The purpose of this paper is to constitute space organization of Cultural and District Centre, daily use of space, user movement, defining the relation between space and function, analysis of the spatial provision of the existing building-new function relationship. Graphs used in order to make analysis of the space formation and space organization corresponding to the new function of Millet Hamam which has been transformed into Cultural and District Centre constitute the whole set of techniques of the space syntax in the study. The face-to-face interviews performed with the users of the building contributed to the study. As a result of the analysis made through using numerical data, locations of the spaces belonging to refunctioned Cultural and District Centre within the building, the compatibility of all the spaces with their new functions, the usage potential of the spaces and the spatial experiences of the users have been interpreted with respect to existing building-new function scale. In the study, positive and negative outcomes have been evaluated in line with the spatial relations by discussing the spatial provision of the new functions in the Cultural and District Centre and suggestions have been made regarding use of the spaces. As a result of the study, it was stated that the correct choice of function in historical buildings that are planned to be re-functional is possible by analyzing the organization of spaces using the graf method and supporting the data obtained with the views of the building users. This study is important in terms of increasing the usage potential of spaces within a newly-functionalized building, which is different compared to other relevant studies.

ANALYSIS OF THE REFUNCTIONED MILLET HAMAM THROUGH SPACE SYNTAX

Space syntax is a model that has been developed based on spatial formation characteristics. The theory of space syntax indicates a strong relationship between spaces and social structures. The concept of space syntax in this study served as a basis for the assessment of the new function displayed by the architectural structure named “Millet Hamamı (Public Hammam)” in Afyonkarahisar, Turkey. The spatial use of another architectural structure named “Kültür ve Semt Evi (Local House of Culture)” that was transformed from Millet Hamamı was analyzed in this study. The purpose of this paper is to constitute space organization of Cultural and District Centre, daily use of space, user movement, defining the relation between space and function, analysis of the spatial provision of the existing building-new function relationship. Graphs used in order to make analysis of the space formation and space organization corresponding to the new function of Millet Hamam which has been transformed into Cultural and District Centre constitute the whole set of techniques of the space syntax in the study. The face-to-face interviews performed with the users of the building contributed to the study. As a result of the analysis made through using numerical data, locations of the spaces belonging to refunctioned Cultural and District Centre within the building, the compatibility of all the spaces with their new functions, the usage potential of the spaces and the spatial experiences of the users have been interpreted with respect to existing building-new function scale. In the study, positive and negative outcomes have been evaluated in line with the spatial relations by discussing the spatial provision of the new functions in the Cultural and District Centre and suggestions have been made regarding use of the spaces. As a result of the study, it was stated that the correct choice of function in historical buildings that are planned to be re-functional is possible by analyzing the organization of spaces using the graf method and supporting the data obtained with the views of the building users. This study is important in terms of increasing the usage potential of spaces within a newly-functionalized building, which is different compared to other relevant studies.

Ultrasound of the neonatal hip as a screening tool for DDH: how to screen and differences in screening programs between European countries.

Developmental dysplasia of the hip comprises a broad spectrum of abnormalities in hip development, of variable severity. Besides physical examination, ultrasound is the preferred imaging modality for screening for developmental dysplasia of the hip in children aged younger than six months. The Graf method is the most widely used ultrasound technique for infant hips; a stepwise approach will be shown in this article. Furthermore, the process of dynamic ultrasound imaging will be explained as well as the use of transinguinal ultrasound in infants wearing a spica cast. There is no consensus on the best way to screen for developmental dysplasia of the hip, which is probably the reason why different screening programs exist throughout Europe, as will be discussed in this article. The use of universal versus selective ultrasound remains a controversy, as does the timing. Is it better to perform sonography in all newborn infants like in Germany and Austria? Or should we examine only the infants with clinical hip instability or risk factors (breech position, positive family history), like in the UK and the Netherlands? This article reviews the epidemiology, static and dynamic ultrasound techniques in screening for developmental dysplasia of the hip, and differences in screening programs throughout Europe. Set aside the uncertainties about whom and when to screen, it needs to be emphasized that ultrasound screening for developmental dysplasia of the hip is important, since the disease is initially occult and easier to treat when identified early. In this way, the radiologist can aid in preventing serious disability of the hip.

Developmental dysplasia of the hip: real world data from a retrospective analysis to evaluate the effectiveness of universal screening.

Developmental dysplasia of the hip is an important cause of disability in children and young adult and it also has a significant socio-economic impact in our society. The main objective of our study is to evaluate, in our hospital, the effectiveness of a universal ultrasound screening protocol and to assess the general knowledge about the theme of pediatricians and neonatologists. Retrospective study of infants born from January 2016 to April 2019, evaluated with hip ultrasound (Graf method). Risk factors assessed were female gender, breech presentation at birth, positive family history and twin birth. For the secondary objective, an anonymous and validated questionnaire was distributed to all pediatricians and neonatologists. Among the 4000 hips analyzed, on ultrasound examination, 98.8% hips resulted mature or immature but appropriate for age, while 1,2% hips were pathological. Analyzing the mature or immature hips, 2,4% were positive on clinical examination and 97,6% were negative. In relation to ultrasound pathological hips, 33,3% have positive clinical examination, while 66,7% negative. From the analysis of risk factors a significant association emerged between female sex, breech presentation and family history with the ultrasound pathological findings. The results of Survey showed that inadequate training about developmental dysplasia of the hip is done during medical school. A universal ultrasound screening allowed us to identify developmental dysplasia of the hip in a number of children with normal clinical examination and no risk factors. Specific training courses should be implemented regarding Developmental Dysplasia of the Hip for neonatologists and pediatricians.

Interobserver reliability in the ultrasonic evaluation with graf method of developmental dysplasia of the hip: the importance of education for ultrasonography classification

Aim: Developmental dysplasia of the hip is a hip deformity that can be diagnosed early by numerous ultrasonic measurements. The purpose of this study was to evaluate the interobserver reliability of ultrasonic measurements using the Graf Ultrasound (USG) method. Methods: Ultrasonic measurements that were used by Graf Ultrasound (USG) method were obtained at presentation for 62 randomized and consecutive patients. Bilateral hip USG measurements were made for each patient. Each USG outcome was evaluated on multiple occasions by an orthopedic surgery specialist, a pediatric specialist, and a 25-year experienced radiologist. The statistical measurements were made by SPSS 20.0 (Windows, IL, USA). Intraclass Correlation Coefficient was determined. 95% Confidence Interval and F Test with True Value 0 was detected. P values were accepted as statistically significantly less than 0,05. Results: At the evaluation before education for Graf USG classification, the results were established. In the interobserver reliabilities, Intraclass Classification Correlations (ICC) values were 0,939 for USG classification evaluation with Graf Method for right hips. ICC values were 0,907 for USG classification evaluation with Graf Method for left hips. At the evaluation after education for Graf USG classification, the results were established. ICC values were 0,975 for USG classification evaluation with Graf Method for right hips. ICC values were 0,970 for USG classification evaluation with Graf Method for left hips. All p values were significant. While before education for Graf USG classification ICC was 0,838 in right hips, 0,765 in left hips; after education, it was 0,928 in right hips, 0,915 in left hips. Conclusion: Diagnosis of DDH deformity with USG is a complex and difficult condition that needs a serious education period. Graf USG method was found to have high interobserver reliability. And also, we detected that education for Graf USG classification increased intra-observer reliability, especially among pediatrists.

Deep Convolutional Neural Network-Based Automatic Classification of Neonatal Hip Ultrasound Images: A Novel Data Augmentation Approach with Speckle Noise Reduction

Neonatal hip ultrasound imaging has been widely used for a few decades in the diagnosis of developmental dysplasia of the hip (DDH). Graf's method of hip ultrasonography is still the most reproducible because of its classification system; yet, the reproducibility is questionable as a result of the high dependency on the skills of the sonographer and the evaluator. A computer-aided diagnosis system may help evaluators increase their precision in the diagnosis of DDH using Graf's method. This study describes a fully automatic computer-aided diagnosis system for the classification of hip ultrasound images captured in Graf's standard plane based on convolutional neural networks (CNNs). Automatically segmented image patches containing all of the necessary anatomical structures were given to the proposed CNN system to extract discriminative features and classify the recorded hips. For ease of evaluation, the data set was divided into three groups: normal, mild dysplasia and severe dysplasia. This study proposes a different approach to data augmentation using speckle noise reduction with an optimized Bayesian non-local mean filter. Data augmentation with this filter increased the accuracy of the proposed CNN system from 92.29% to 97.70%. This new approach for automatic classification of DDH, classifies dysplastic neonatal hips with a high accuracy rate and might help evaluators to increase their evaluation success.

Early detection of developmental dysplasia of hip by ultrasound.

To assess the effectiveness of early universal ultrasound (US) screening of developmental dysplasia of the hip (DDH). A prospective study of universal hip screening of all mature neonates was conducted from 2012 to 2013, at the Department of Obstetrics and Gynaecology, University of Szeged; 1636 newborns (3272 hips) had clinical examinations and hip ultrasound by the Graf method within the1st 3 days of life. Prevalence of DDH, risk factors, sensitivity and specificity of clinical examinations were evaluated. At the 1st US, 70 of the examined 3272 hips (2.14%) were found to be positive. According to Graf categories, the following distribution was observed: type II C, 21 hips (30.0%); D, 24 hips (34.28%); III, 24 hips (34.28%); IV, 1 hip (1.44%). Regarding the risk factors, female gender, breech presentation and positive family history proved to be significant. Interestingly, 28 (50.90%) of the 55 newborns with DDH had neither positive physical signs nor any risk factors, except being female. The physical examination was calculated for sensitivity (20.0%) and specificity (98.34%). In our 1-year period study, 50.9% of the newborns with DDH had neither any positive physical signs nor any risk factors, except being a female. In contrast, early universal US screening of the hip facilitated to diagnose all cases with hip dysplasia. Hip sonography is an effective mode of prevention in orthopaedics, however further studies are needed to compare the rates of operative procedures in selective versus universal screening models.

Optimizing the Time for Developmental Dysplasia of the Hip Screening: Earlier or Later?

Developmental dysplasia of the hip (DDH) is still a common and important disorder of childhood, with a prevalence of 0.1 to 2/1000 children. Using ultrasonography (US) in screening of DDH reduces the rates of open reductions and complications. In the current study, we aim to detect the optimal time for US examination for detecting DDH to prevent unnecessary repeating US examinations and treatments. Children referred to US examination for a healthy child screening program, according to the health policy of our country, are included in the current prospective study. Both hips of each child were sonographically examined by the same radiologist using Graf's method at 4th, 8th, 12th weeks of life. A total of 2020 hips of 1010 children were examined. Fourth-week US results can predict 12th-week results (right hip: sensitivity 100%, specificity 75.7%; left hip: sensitivity 100%, specificity 78.3%). Eighth-week US results can predict 12th-week results (right hip: sensitivity 100%, specificity 87.5%; left hip: sensitivity 100%, specificity 83.9%). In predicting 12th-week US results, 8th-week results are found to be more successful than 4th-week results. Late diagnosis of DDH might cause serious public health problems. On the other hand, early US examinations can result in false-positive diagnosis. Unfortunately, there is still confusion about the optimal time for DDH screening with US, especially among radiologists who are not specialized in DDH sonography. A US scan performed at eighth week of life can predict any pathology presence safely and correctly.

ORTHOPEDIC ASSESSMENT OF THE HIPS IN NEWBORNS AFTER INITIAL PEDIATRIC SURVEY.

ABSTRACTObjective:To analyze and follow-up patients previously selected by pediatricians at the time of birth who presented altered initial physical examination results to identify the pathological changes in their hips.Methods:A prospective cohort study was conducted involving 34 newborns (68 hips) out of a total of 1273 live births; these infants were assessed within the first days of life as altered findings were noted in the initial examination by the pediatrician. The results of clinical and ultrasonographic examination performed using the GRAF method and of specific treatments were analyzed.Results:Of the 68 hips in 34 patients, 2 hips in 2 patients required intervention using the Pavlik harness for 8 weeks; a satisfactory treatment outcome was obtained in both cases.Conclusions:Despite the low orthopedic workload in medical courses, it was possible to identify data consistent with the literature, both in the presentation of clinical findings and in those that required treatment, indicating that an initial evaluation of all newborns is mandatory, especially those with risk factors. Level of evidence IV, case series.

The predictive value of the clinical sign of excessive hip abduction for developmental dysplasia of the hip (DDH)

Aim To assess the relationship between the clinical sign of excessive hip abduction (abduction of the hip 90 degrees or more) and developmental dysplasia of the hip (DDH). Methods The research was conducted on 450 newborns in the Neonatal Unit at the Clinic of Gynecology and Obstetrics and the Clinic of Orthopedics and Traumatology of the University Clinical Centre, Tuzla, between 30th August 2011 and 30th April 2012. Clinical (degree of hip abduction) and ultrasound examination of all newborns hip were performed using the Graf method on their first day of life. Results Clinical sign of excessive hip abduction showed significant predictive value for DDH. There were 37 (8.2%) newborns with the clinical sign of excessive hip abduction, of which 13 of them had DDH while 24 of them did not have this clinical sign. There were 89 newborns, in the overall sample, with one of the forms of DDH, 13 (12.7%) of them had this clinical sign, while from 324 newborns witouth DDH, 24 (6.9%) had this clinical sign. Excessive hip abduction had a positive predictive value (PPV) of 35.1% and a negative predictive value (NPV) of 78.5% for DDH. Conclusion Excessive hip abduction is an useful and important clinical sign of DDH. Doctors who perform the first examination of the child after birth, would have to turn their attention to this clinical sign. The newborns with this clinical sign would have to go to an ultrasound examination of the hips for further diagnosis.

Ultrasonography of borderline and asymmetric infant hips - a challenge in the management of developmental dysplasia of the hip.

Background and aimDevelopmental dysplasia of the hip (DDH) is a potentially disabling disease. There are many diagnostic approaches, Graf method ultrasonography being the most popular imaging method. Although considered as a healthy condition, the existence of hips at the 60 degree limit or the asymmetries higher than 4 degrees between left and right side may be a source of unfavorable evolution and consequently of late diagnosed dysplasia cases.MethodsThe retrospective study was conducted in the Radiology Department of the Emergency Clinical County Hospital Cluj-Napoca, by retrospective analysis of the database containing 3013 records of the subjects presented for DDH assessment between January 2008 and December 2014. The study focuses on investigating two possible sources of missed cases by clinical-ultrasound management of DDH: borderline and asymmetric hips. Two conditions were studied in patients considered healthy according to Graf method: borderline hips (those with α angle value of 60° and 61°) and asymmetric hips (left to right difference between the α angle values exceeds 4°). Three study groups were formed: healthy subjects, asymmetric/borderline subjects and patients with immature or mild dysplasia. The incidence of risk factors, clinical suspicion and the success of therapy were evaluated.ResultsThere were no significant differences between the three groups regarding the role of the risk factors in DDH pathogenesis. Data reveal a high suspicion rate after the clinical examination, in groups II and III, compared to the healthy population. This means that from this point of view, Group II might be considered having at least a dysplastic prognosis. An increased correlation in the therapeutic results was observed between Group II patients and those from mild delayed maturation subgroups from Group III (IIa−, IIa+).ConclusionsAsymmetric and borderline hips should be approached similarly to immature hips, clinical suspicion and the therapeutic outcome being similar.

The value of femoral head coverage in the follow-up of infants with developmental dysplasia of the hip

Objective To discuss the value of femoral head coverage (FHC) in the follow-up of infants with developmental dysplasia of the hip(DDH). Methods Two hundred and seventeen DDH infants(434 hips) diagnosed by clinical examination and ultrasonography were chosed as treatment group, and then received the brace treatment and followed up with ultrasonography. Four hundred and sixteen infants(832 hips) with normal hips diagnosed by clinical examination and ultrasonography were chosed as control group. The ultrasonographic examination included Graf method and FHC measurement. The infants in the treatment group were followed up with ultrasonography examination up to the age of 6 months. Results The FHC in the control group was (59.69±4.36)%. In the treatment group, 302 hips were diagnosed to be DDH.Among them, 36 hips were Graf type Ⅱa, 132 hips were Graf type Ⅱb, 69 hips were Graf type Ⅱc, 8 hips were Graf type D, 41 hips were Graf type Ⅲ, and 16 hips were Graf type Ⅳ. The FHC of these hips were (51.33±5.18)%, (53.07±3.94)%, (44.52±5.32)%, (38.70±5.85)%, (27.23±6.82)% and 0, respectively. After treatment, 222 hips became Graf type Ⅰ, 49 hips were improved, and their FHC increased. Twenty-eight hips were not significantly improved after treatment, but the FHC of most hips (including 14 hips of type Ⅱb, 3 hips of Ⅱc and 4 hips of type Ⅲ) increased. Three hips of Graf type Ⅲ aggravated to Graf type Ⅳ, and the FHC decreased to 0. Conclusions The FHC has important value in the follow-up of infants with DDH. Key words: Ultrasonography; Developmental dysplasia of the hip; Femoral head coverage; Infant; Follow-up

Perfil dos lactentes diagnosticados com displasia do desenvolvimento do quadril

ObjectiveTo describe the profile of patients with developmental dysplasia of the hip (DDH), diagnosed by means of physical and ultrasound examination. Implement the protocol for treatment and follow‐up of DDH. MethodsA cross‐sectional study was carried out that included DDH patients born between January 2014 and December 2016, in the city of Pelotas, in Southern Brazil. Race, sex, birth weight, fetal position, side of the hip, gestational age, maternal, and family history were considered. The data on the medical record were compared with the characteristics of the general population through the National Information System on Live Births (Sistema de Informação sobre Nascidos Vivos [SINASC]). ResultsThirty‐three DDH patients were identified, the majority being female, presenting a four‐fold higher probability of presenting the pathology (p < 0.001), and the left side was more affected. No statistically significant association was found with the following factors: birth weight, gestational age, race, and maternal age. The babies on breech position had a 15‐fold higher probability of DDH (p < 0.001). Twenty‐one children required immediate treatment of the hips, with ultrasound showing classification IIb or more, by the Graf method, or radiography showing dislocation in DDH patients older than 6 months of age. ConclusionDDH screening is essential in all newborns; the physical examination, when altered, should be complemented with ultrasound to avoid late diagnosis of the disease.

Reproducibility of acquiring ultrasonographic infant hip images by the Graf method after an infant hip ultrasound training course.

The objective screening of infant hips using ultrasonography (Graf method) is gaining favor in the diagnosis of developmental dysplasia of the hip in Japan. However, the accuracy of the Graf method is dependent on the examiner's experience and technique. The purpose of this study was to investigate the reproducibility of acquiring ultrasonic hip images and their evaluation after examiners attended an infant hip ultrasound training course. Ultrasonic images of 70 hips of 35 newborns who were screened by ultrasonography using the Graf method, were evaluated. The images were acquired by two inexperienced examiners who attended the training course. The inter- and intra-examiner measurement errors as well as reproducibility were calculated based on the images obtained. The intra-examiner measurement error in the acquired images of the same hip was minor. The inter-examiner measurement error was also small. The intra- and inter-examiner agreements of the Graf classification were high. The intra-examiner reproducibility of the acquired ultrasonic images was substantial, and the inter-examiner reproducibility was almost perfect. Our results demonstrated that inexperienced examiners could obtain ultrasonic infant hip joint images with minor differences and high reproducibility after the training course. Our findings raise the possibility of extending the infant hip ultrasound course in Japan.

The predictive value of the clinical sign of limited hip abduction for developmental dysplasia of the hip (DDH).

Aim To assess the relationship between the clinical sign of limited hip abduction and developmental dysplasia of the hip (DDH). Methods A research was conducted on 450 newborns at the Neonatal Unit at the Clinic of Gynaecology and Obstetrics and the Orthopaedics and Traumatology Clinic of the University Clinical Centre, Tuzla, between 30th August 2011 and 30th April 2012. Clinical (degree of hip abduction) and ultrasound examination of all newborns' hips were performed using the Graf method on their first day of life. Results Clinical sign of limited hip abduction showed significant predictive value for DDH. There were 67 (14.7%) newborns with the clinical sign of limited hip abduction, of which 26 (5.7%) were on the left hip, 11 (2.4%) on the right hip and 30 (6.6%) on both hips. Limited hip abduction had a positive predictive value (PPV) of 40.3% and a negative predictive value (NPV) of 80.4% for DDH. Conclusion Limited hip abduction, especially unilateral, is a useful and important clinical sign of DDH. Doctors, who perform the first examination of the child after birth, would have to pay attention to this clinical sign. Newborns with this clinical sign would have to go to an ultrasound examination of the hips for further diagnosis.