Earliest diagnosis of congenital dislocation of the hip by ultrasonography. Historical background and present state of Graf's method

Abstract

Since Graf in 1978 introduced sonography into examination of hip dysplasia and hip dislocation, we survey an experience of more than 38,000 infant hips. At the present sonography of the infant hip is a standard and superior to traditional diagnostic methods especially in infants under three months of age, if the following minimum requirements are fulfilled: 1. THEORETICAL AND PRACTICAL TRAINING OF THE METHOD: anatomic identification (landmarks, standard situation, standard plane), description and nomenclature of the sonographic hip types according to GRAF, measurement (bony roof angle "alpha", cartilage roof angle "beta"), dynamic examination, therapeutic consequences and follow-up, points of weakness and errors of measurement. 2. CERTAIN TECHNICAL STANDARDS OF THE ULTRASOUND INSTRUMENT: linear scanner, 5 MHZ (newborn: 7.5 MHZ). POSITIONING-DEVICE (patent: Fa Radl, A-8010 Graz-Austria) 3. SUFFICIENT DOCUMENTATION: projection similar to a ap-radiograph of the right hip, image scale never less than 1:1, black on white, two ultrasound scans per hip in the standard-plane. Suitable Systems: multiformat, dry copy, computer printout. Follow-up-studies have proved that in our region approximately five percent of hips under the age of three months require treatment, and that prognosis is better the earlier therapy is started. For this reason we recommend a sonographic screening of the newborn not later than six weeks of age.