Screening for developmental hip dysplasia (DDH)—clinically or sonographically? Comments to the current discussion and proposals

Riccabona, Michael; Schweintzger, Gerolf; Grill, Franz; Graf, R.

doi:10.1007/s00247-012-2578-9

Cited by 9 publications

(5 citation statements)

References 3 publications

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“…This can be explained by the wider acceptance, in the last years, of universal US screening idea without taking into account the baby's gender. In the same context, better information on the need to perform hip US led to a decrease of the average age at first presentation in the second group, closer to the recommended age of 4-6 weeks [17].…”

Section: Discussionmentioning

confidence: 81%

A new sign in the standard hip ultrasound image of the Graf method.

et al. 2015

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Aim: The aim of the study was to assess the usefulness of obtaining a 90 0 angle between the plane of the osteochondral plate and the surface of the transducer during standard hip ultrasonography according to Graf method. Material and methods: In this retrospective study 1078 patients (2156 hips) were included examined between 2008 and 2014 for developmental dysplasia of the hip (DDH) ultrasound screening. The patients were divided in two groups. Group I consisted of 402 patients examined between January 2008 and December 2011 using the standard Graf method. Group II consisted of 676 patients examined from January 2012 to December 2014 using the Graf method with an additional criterion: 90 0 angle between the plane of the osteochondral plate and the surface of the transducer. Results: We found more dysplastic patients in group I comparing to group II: 55 (13.7%) and 38 (5.6%) respectively. The difference in the incidence of patients diagnosed with DDH was highly significant (p<0.001). The mean alpha angle value in group I was 65.31 0 , respectively 67.52 0 for group II (p<0.001). Conclusion: The new osteochondral plate sign has the potential to reduce the overdiagnosis of DDH and provide a better tailored approach to borderline hips.

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Section: Discussionmentioning

confidence: 81%

A new sign in the standard hip ultrasound image of the Graf method.

et al. 2015

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“…Ultrasonography will not only prevent the occurrence of such problems in adults, but will also contribute to the reduction in surgical treatment costs of DHD [25,26]. Although USG reduces the problems and treatment costs of the family and the child in the future, it may cause false positives and unnecessary treatments [27].…”

Section: Discussionmentioning

confidence: 99%

The evaluation of ultrasonographic hip measurement differences among physicians according to the Graf method in newborns

et al. 2022

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Background/Aim: Hip ultrasonography (USG) is the most important diagnostic method in developmental hip dysplasia in newborns. However, a disadvantage of the ultrasonography method is that there can be measurement differences among doctors measuring the same hip. We aimed to investigate the causes and solutions of this situation. We further strived to measure the hip ultrasonography performed by different physicians using the Graf method and comparing the obtained values. Methods: Hip USGs of newborns admitted to Malatya Turgut Ozal University Faculty of Medicine Hospital between Jan. 8, 2020 and Jan. 5,.2021 were measured and classified using the Graf method. The study type is consistent with retrospective cohort studies. Newborns aged 0-22 weeks without any additional pathology were included in the study. A radiologist and two orthopedists measured and interpreted the images separately in accordance with the Graf method. The first hip measurements (R1) were made by the radiologist (R) with the USG device, and they were classified according to alpha and beta angles; two printouts were made. The first orthopedic specialist (OS1) and the second orthopedic specialist (OS2) made their measurements with printouts. Subsequently, the results from the physicians were compared. Results: A statistically significant difference was found between R1-OS2 (P < 0.001) and OS1-OS2 (P < 0.001) in terms of the Graf classifications. No statistically significant difference was found between R1 and OS1 in terms of the Graf classification (P = 0.562). A statistically significant difference was found between R1-OS2 (P < 0.001) and OS1-OS2 (P = 0.048) angles (alpha and beta) measurements. While R1 and OS1 measurements were compatible with each other, OS2 measurements were found to be inconsistent. Conclusion: We think that there may be differences in angle measurements and the Graf classification among physicians who perform hip ultrasonography in newborns, and the most important way to correct this is through regular participation of physicians in subject-specific trainings.

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“…Some discussions about hip sonography and screening came up [9]. In the literature different techniques are mixed up, modifications of "Graf-technique", which cannot work and leads to catastrophes or have the standard of the 1980 th.…”

Section: Discussionmentioning

confidence: 99%

Hip sonography worldwide – experience, results, problems

Graf¹,

Synder²

2020

Chir. Narzadow Ruchu Ortop. Pol.

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Introduction. There is a confusion in the literature about the value of baby hip sonography to detect DDH. One of the reasons is, that different examination techniques with different results are used and the final results are mixed up. Materials and methods. The principles of the "Graf technique" with well-known common mistakes are described with the typing as a mirror of the pathoanatomical situation in the joint and compared with the other techniques. Results. According the German Quality Commission in 48% a wrong anatomical identification of the echoes leads to a wrong diagnosis. Checklist I (anatomical identification) and Checklist II (usability check) are necessary absolutely. The reason, why modified or other techniques leads to overdiagnosis or wrong diagnosis are pointed out: No standard plane, tilting effects, age not taken into account, no differentiation between instability and elastic wiping etc). More than 25 years general screening in some countries demonstrate the success: Operations as well as conservative treatment rate and costs dropped down dramatically. Conclusions. Hip sonography is not hip sonography. A special licenses after a training course in the technique by authorized teachers is necessary to keep the standard high. Sonograms must be comparable and independent from the experience and skill of the examiner. Modified or other techniques are not the standard of today and in some countries forbidden. Screening depends from the health systems in different countries also. But prevention is better than operation.

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Screening for developmental hip dysplasia (DDH)—clinically or sonographically? Comments to the current discussion and proposals

Cited by 9 publications

References 3 publications

A new sign in the standard hip ultrasound image of the Graf method.

A new sign in the standard hip ultrasound image of the Graf method.

The evaluation of ultrasonographic hip measurement differences among physicians according to the Graf method in newborns

Hip sonography worldwide – experience, results, problems

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