RELATIONSHIP BETWEEN GRAF ANGLES AND FEMORAL HEAD COVERAGE IN HIP ULTRASOUND SCREENING FOR DEVELOPMENTAL HIP DYSPLASIA
DOI:
https://doi.org/10.53582/qte5ak55Keywords:
hip ultrasonography, Graf classification, femoral head coverageAbstract
Introduction: Ultrasound examination is a widely accepted method for developmental hip dysplasia screening, diagnosis and treatment monitoring. The Graf technique, routinely used in the Republic of North Macedonia is reliable and reproducible when performed in a precise and standardized manner, but it can be challenging when used by inexperienced ultrasonographers. We analyzed the relationship between findings of ultrasound scans obtained by the Graf method and femoral head coverage (FHC), in order to examine its usefulness in infant hip screening.
Material and methods: Hip sonograms of 105 infants aged 0 to 6 months were examined. Measurements of alpha and beta angles according to Graf were performed and FHC was calculated as d*/D ratio. Multiple regression analysis was performed to examine the relationship between FHC, alpha and beta angles and infant age.
Results: Two hips in a single patient were abnormal (grade 2c and D) according to Graf technique, with incidence of 0.95%. Seven hips (3.3%) had FHC below 50%, including the 2c and D hips and five hips with Ib grade according to Graf. FHC increased for 0.71% for each degree increase of alpha angle and decreased for 0.68% for each degree increase of beta angle. Infant age did not influence FHC.
Conclusion: There was a positive correlation between alpha angle and FHC and negative correlation between beta angle and FHC. FHC above 50% is strongly indicative of normal hip morphology. FHC can be used in addition to the Graf method for assessment of infant hips.
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Copyright (c) 2026 Danica Popovska, Magdalena Manasieva, Roza Djoleva - Tolevska, Nenad Atanasov, Aleksandar Saveski, Milena Bogojevska Doksevska, Daniela Georgieva
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