Hip Sonography for Developmental Dysplasia of the Hip: The Graf Method
Developmental Dysplasia of the Hip (DDH) is one of the most common musculoskeletal disorders for children. Multiple risk factors as female sex, positive family history, breech positioning in utero are blamed for the presentation of this entity. The hip joint of the infant is affected and more specifically, the acetabulum remains shallow and the femoral head grows in a wrong position. Until 1980 the diagnosis was based on clinical examination (Barlow and Ortolani maneuvers) and radiological imaging. The diagnosis was not certain and many cases remained undiagnosed until childhood or adolescence. In 1980 Prof. Reinhard Graf presented his ultrasonographic method for the examination of the infant hip joint. This method evaluates the bony and cartilaginous coverage of the femoral head by the acetabulum in the infantile joint by measuring α-angle and β-angle. Using and valuating these measurements the hip joint is later on classified by Graf classification (Types I-IV) and each type corresponds to a specific treatment option. Graf method is the most used ultrasonographic examination in many European countries and has contributed to the reduction of neglected DDH cases and decreased the number of complex pelvic operations that children with dysplastic hips should undergo to be cured.
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