THE GRAF GRADE 2C HIP

Abstract

Introduction: Controversy continues over the value of routine ultrasound hip screening and the question of whether the outcome of hips with dysplasia detected by ultrasound can be improved with treatment. Graf describes a group of infants in whom ultrasound demonstrates a hip that is in joint and centred yet severely dysplastic. These are classified as Grade 2c and are important because, although they may be clinically stable on presentation, they are at risk of progressing to dislocation.

Method: Cases were identified in which failure to recognize and/or treat Grade 2c hips lead to subluxation or dislocation of the joint. They were collected from centres where neonates had ultrasound examination of the hip as part of a selected screening program.

Results: Eight cases from four UK centres, showing deterioration in untreated Grade 2c hips. All were identified on retrospective Graf grading. Five patients underwent open reduction.

Discussion: The Graf method of hip ultrasound examination has not been widely accepted in the UK. Some authors believe that stable dysplastic hips will correct with growth and that treatment confers no specific advantage. However, an advantage of Graf’s method is that it can detect the centred, frequently ‘stable’ hip that will deteriorate in time; the Grade 2c hip. These cases illustrate the importance of recognising and appropriately managing this group of patients who will account for a proportion of late presenting cases of DDH.