· Graf hip ultrasound

Graf hip ultrasound: learn it on one image

Image: Walter SG et al., Front Pediatr 2022;10:990806, Fig. 2 (cropped; in screen view rotated and flipped so that cranial is on the left), CC BY 4.0. The original authors' printed labels and arrows were removed digitally (inpainted); faint smoothing may remain where they were. All labels now come from this page. The coloured overlays are added here: landmark positions are hand-placed approximations, and the simulation in step 12 is a schematic drawn over the image, not a real dysplastic scan.

Step 1 of 12

About this lesson

The Graf method is the standard way to assess an infant hip with ultrasound for developmental dysplasia of the hip (DDH). You take one coronal image of the hip in a standard plane, check that the image is usable, draw three lines, and read two angles: α, for the bony roof, and β, for the cartilage roof. Those two angles and the baby's age give the hip a type, from Ia (mature) to III/IV (dislocated).

It is written for radiology residents, and for anyone else learning to scan or report infant hips. It assumes basic ultrasound knowledge and nothing about Graf. It is a study aid, not a substitute for supervised scanning.

The classification at a glance

Typeα (bony roof)β (cartilage roof)AgeMeaning
Ia≥60°≤55°anyMature hip
Ib≥60°>55°anyMature hip (transitional cartilage roof)
IIa (+/−)50–59°>55°≤3 monthsPhysiologically immature. IIa+ is α 55–59° (on track); IIa− is α 50–54° at about 6 weeks (lagging).
IIb50–59°>55°>3 monthsDelayed ossification
IIc43–49°≤77°anyCritical: a shallow socket, but the head is still centred
D43–49°>77°anyDecentring: the head is starting to leave the socket
III / IV<43°—anyDislocated. III and IV are told apart by the position of the labrum (general knowledge), not by angles.

Thresholds: Ömeroğlu 2014, Table 1 [2]. Management depends on local protocol and is not covered here.

Self-test

References

  1. Graf R. Classification of hip joint dysplasia by means of sonography. Arch Orthop Trauma Surg. 1984;102(4):248–55. doi:10.1007/BF00436138
  2. Ömeroğlu H. Use of ultrasonography in developmental dysplasia of the hip. J Child Orthop. 2014;8(2):105–13. doi:10.1007/s11832-014-0561-8 (Table 1; standard plane)
  3. Walter SG, et al. Four decades of developmental dysplastic hip screening according to Graf: what have we learned? Front Pediatr. 2022;10:990806. doi:10.3389/fped.2022.990806 (Fig. 2: checklists and the image used here, CC BY 4.0)

Points marked "general knowledge" are standard teaching that was not checked against these sources. This applies especially to the practical scanning tips in steps 1–2.

Radyssey · For education only, not clinical advice. · Suggest an improvement or report an error