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The risk of DDH between breech and cephalic-delivered neonates using Graf ultrasonography
Stylianos Kolovos1, Spyridon Sioutis2, Maria Polyzou3
1Department of Orthopaedics, General Hospital of Larisa, Larisa, Greece.
Insights
Developmental dysplasia of the hip (DDH) is less common in breech-delivered infants than previously thought. Most breech-born infants initially diagnosed with DDH in Phase 1 are healthy, showing normal hip development by later phases.
Area of Science:
- Pediatrics
- Orthopedics
- Neonatal Care
Background:
- Developmental dysplasia of the hip (DDH) is a common infant musculoskeletal disorder.
- Key risk factors include female gender, breech presentation, left hip involvement, and family history.
Purpose of the Study:
- To compare DDH incidence in breech- versus cephalic-delivered neonates.
- To investigate distinct hip joint maturation patterns in breech-delivered infants.
Main Methods:
- Prospective study of 618 hip joints (309 newborns) using the Graf method.
- Hips examined in four phases (0-10 weeks), measuring alpha and beta angles.
- Statistical analysis to compare maturation patterns between delivery positions.
Main Results:
- Phase 1 showed a significant DDH incidence difference: 35.6% (breech) vs. 8.6% (cephalic).
- This difference decreased significantly in subsequent phases (Phase 4: 1.7% vs. 0%).
- Breech-delivered infants showed a marked decrease in DDH incidence from Phase 1 to Phase 4.
Conclusions:
- A difference in DDH incidence exists between breech and cephalic deliveries, but it's less significant than previously assumed.
- Many breech-delivered infants initially classified as pathological (Phase 1) normalize by later ultrasound evaluations (Phases 2-4).
- This suggests potentially different hip joint maturation patterns influenced by delivery position.
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.
