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Can a Hip Diagnosed as Graf Type 1According to Graf Checklist Deteriorate Over Time? A Case Series and Evaluation of
Cuneyd Gunay1, Hakan Atalar2, Ahmet Yigit Kaptan2
1Department of Orthopaedics and Traumatology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
Insights
Mature Type 1 hips diagnosed using the Graf method should not worsen. Cases reported as worsening Type 1 hips were likely due to initial misdiagnosis on hip sonograms.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
Background:
- The Graf method is a standard for assessing hip development in infants.
- Mature Type 1 hips are considered stable and not expected to deteriorate.
Observation:
- Literature review identified cases initially classified as Graf Type 1 hips that later worsened.
- Analysis of sonograms from these cases revealed potential diagnostic errors.
Findings:
- Inappropriate sonogram measurements can lead to incorrect Graf Type 1 hip diagnoses.
- Deficiencies in applying the Graf checklist were noted in reviewed cases.
- Worsening of Graf Type 1 hips is typically linked to initial diagnostic inaccuracies.
Implications:
- Accurate application of the Graf method and checklist is crucial for correct hip dysplasia diagnosis.
- Re-evaluation of sonogram techniques may be necessary to prevent misdiagnosis of Graf Type 1 hips.
- Correctly identified mature Graf Type 1 hips are unlikely to worsen under normal circumstances.
Introduction:
According to the Graf method, mature Type 1 hips will not worsen overtime. However, some cases have been reported in literature of hips which were initially Graf Type 1 hips and then worsened later. Our aim is to show the mistakes of the hip sonograms, which had been diagnosed as a mature Graf Type 1 hips.
Case Report:
A review of literature revealed four studies initially diagnosed as Graf Type 1 hips and which then worsened overtime. Professor Graf has previously stated that measurements from inappropriate sonograms may result in an incorrect diagnosis. In this paper, the four aforementioned studies and their sonograms reported in literature were evaluated according to the Graf technique. In the light of the findings, it was discussed whether a mature hip could worsen overtime. In the reported cases, some of the deficiencies according to the Graf checklist were determined.
Conclusion:
From this examination, it can be concluded that Type 1 mature hips which worsened overtime, except for special circumstances as previously mentioned by Professor Graf, are related to an initial wrong diagnosis. As a result, if a Graf Type 1 hip was determined appropriately according to Graf checklist, it will never worsen later in normal circumstances.
