title: Ultrasonographic Graf type IIa hip needs more consideration in newborn girls.
abstract: OBJECTIVE
  According to hip ultrasonography by Graf's method, the type IIa hip has a certain degree of physiological delay in ossification of the bony acetabular roof. The aim of this case-control study was to evaluate the natural history of the type IIa hip.
  
  
  METHODS
  Four hundred and thirty-one type IIa hips were identified in 312 of 1,690 ultrasonographically screened newborns with a mean age of 27 days. Parents were accurately informed about the prognosis of such a hip condition and invited for ultrasonographic re-examination at 6-7 weeks of age.
  
  
  RESULTS
  Type IIa hip was more common in newborn girls than in boys (P < 0.001). Among 431 type IIa hips, 146 (34 %) missed the follow-up examination at 6-7 weeks of age. Among the completely followed 285 hips, 225 (79 %) developed into a normal hip at 6-7 weeks of age. Newborn boys' hips had a higher rate of spontaneous normalization than girls' hips at 6-7 weeks of age (P = 0.006). All but one type IIa(+) hip became type I without any treatment. According to our management protocol, 35 type IIa(-) hips and one type IIa(+) hip, which later became type IIb, underwent treatment. The rate of treatment was higher in newborn girls' hips than in boys' hips (P = 0.019).
  
  
  CONCLUSIONS
  As Graf type IIa hip is more common, has a lower rate of spontaneous normalization and higher rate of treatment in newborn girls than in boys, we recommend paying more attention the type IIa hip in newborn girls. The rate of missing the required follow-up is unacceptably high due to parents' insensitivity regarding the type IIa hip.
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Eskişehir Osmangazi University, 26480 Eskişehir, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Omeroğlu
authors.affiliation: Department of Orthopaedics and Traumatology, Private Ortopedia Hospital, Adana, Turkey.
authors.forename: Remzi
authors.initials: R
authors.lastname: Caylak
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Eskişehir Osmangazi University, 26480 Eskişehir, Turkey.
authors.forename: Ulukan
authors.initials: U
authors.lastname: Inan
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Eskişehir Osmangazi University, 26480 Eskişehir, Turkey.
authors.forename: Nusret
authors.initials: N
authors.lastname: Köse
keywords: Developmental dysplasia of the hip; Graf type IIa hip; Hip ultrasonography