title: Anterior dynamic ultrasound and Graf's examination in neonatal hip instability.
abstract: BACKGROUND
  Discrepancy between neonatal hip morphology and stability has been reported in the literature. Comparative ultrasound studies on this issue are limited.
  
  
  OBJECTIVE
  To compare neonatal hip instability, as assessed by dynamic ultrasound and clinical examination, with acetabular morphology, as assessed by Graf's method.
  
  
  METHODS
  536 newborn infants with clinical signs of hip instability, ambiguous findings at clinical hip examination, or positive risk factors for DDH were investigated with two ultrasound methods, the Graf method and anterior dynamic ultrasound, at an average age of 12 days. The hips were allocated to three groups according to the Graf result: A, normal (type Ia and b); B, borderline or immature (type IIa); and C, pathologic (type IIc and worse). Graf examination was compared with two diagnostic tests for instability, namely clinical examination by senior pediatric orthopedists and anterior dynamic ultrasound.
  
  
  RESULTS
  According to Graf's method, 77% of the hips were normal, 20% borderline/immature, and 3% pathologic. On clinical hip examination, 82% were stable, 14% unstable, and 4% dislocatable. The dynamic ultrasound outcome was 88% stable hips, 10% unstable, and 2% dislocatable. Of the hips considered unstable or dislocatable on dynamic ultrasound, 21% had normal (type I) and 66% immature acetabular morphology according to the Graf method. Of the hips that were stable on dynamic ultrasound, only one (0.1%) was dysplastic according to the Graf method. Graf's examination showed the smallest number of normal hips, but also the fewest pathologic hips, with many indeterminate results that needed follow-up.
  
  
  CONCLUSIONS
  Acetabular morphology correlated better to stability as assessed by dynamic ultrasound than to the clinical examination results, with fair to moderate agreement. Graf's examination resulted in a large number of indeterminate results that needed follow-up, but when used as the sole criterion for deciding treatment did not lead to a higher treatment rate than when the decision was based on clinical hip examination.
authors.affiliation: Department of Pediatric Radiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden. throstur.finnbogason@karolinska.se
authors.forename: T
authors.initials: T
authors.lastname: Finnbogason
authors.forename: H
authors.initials: H
authors.lastname: Jorulf
authors.forename: E
authors.initials: E
authors.lastname: Söderman
authors.forename: L
authors.initials: L
authors.lastname: Rehnberg
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging; D005260:Female; D006618:Hip Dislocation, Congenital / Q000175:diagnosis*; D006621:Hip Joint / Q000000981:diagnostic imaging*; D006801:Humans; D007231:Infant, Newborn; D007593:Joint Instability / Q000175:diagnosis*; D008297:Male; D015997:Neonatal Screening / Q000379:methods; D015588:Observer Variation; D010808:Physical Examination / Q000379:methods* / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D014463:Ultrasonography