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The risk of DDH between breech and cephalic-delivered neonates using Graf ultrasonography

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Abstract

Purpose

Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal disorder in infants. The most significant risk factors include female gender, breech presentation, left hip and family history. In this study, we utilized the Graf method at different time intervals to evaluate both breech-delivered and cephalic-born newborns. The objectives were to compare the incidence of DDH in cephalic and breech-delivered neonates and investigate whether the hip joints of neonates delivered in the breech position exhibit a distinct maturation pattern.

Material and methods

We studied prospectively 618 hip joints (309 newborns). Each hip joint was examined with the Graf method in four time periods as follows: Phase #1 (0–1 weeks), Phase #2 (1–4 weeks), Phase #3 (4–7 weeks), and Phase #4 (7–10 weeks). The α and β angles for each hip joint were measured, and the hips were classified according to Graf classification. With our statistical analysis within the different phases, we were able to investigate potential variations in the maturation patterns between newborns delivered in the breech and cephalic delivery positions.

Results

A significant difference (at the 5% level) was observed in Phase 1 between breech and cephalic-delivered neonates (35.6–8.6%). This difference tended to decrease in next phases (13.6–1% in Phase 2, 2.5–0% in Phase 3 and 1.7–0% in Phase 4). A significant difference (at the 5% level) for cephalic-delivered neonates was also observed between Phase 1 and Phase 4 (8.5–0%), but the percentages were low. Additionally, the breech-delivered had extreme difference in incidence of DDH from Phase 1 to Phase 4 (35.6–11.9%, 2.5%, and 1.7%, respectively).

Conclusion

It appears that there is an actual difference in the incidence of DDH between breech-delivered and cephalic-delivered neonates, although the difference may be less significant than previously considered. The majority of the breech-delivered neonates that were initially considered as pathological (Phase 1) are, in fact, healthy. This is ascertained in subsequent ultrasound examinations conducted in later phases (Phases 2–4), when the incidence of pathological cases decreases. This could be attributed to potential different maturation pattern between these groups.

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No benefits have been or will be received from a commercial party related directly or indirectly to the subject matter of this article.

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Authors and Affiliations

  1. Department of Orthopaedics, General Hospital of Larisa, Larisa, Greece

    Stylianos Kolovos

  2. First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece

    Spyridon Sioutis, Vasileios Karampikas, Pavlos Altsitzioglou, Dimitrios Serenidis, Dimitrios Koulalis, Panayiotis J. Papagelopoulos & Andreas F. Mavrogenis

  3. Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany

    Maria Polyzou

  4. Third Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece

    Maria-Eleni Papakonstantinou

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  1. Stylianos Kolovos
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Correspondence to Andreas F. Mavrogenis.

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Kolovos, S., Sioutis, S., Polyzou, M. et al. The risk of DDH between breech and cephalic-delivered neonates using Graf ultrasonography. Eur J Orthop Surg Traumatol 34, 1103–1109 (2024). https://doi.org/10.1007/s00590-023-03770-0

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