Ultrasound screening of the newborns Hips by prof.Graf

Ultrasound screening  of the newborns Hips by GrafAccording to Graf

ultrarsound examination perform by orthopaedics:

1. It is recommended that every infant at the  Maternity unit should  undergo an ultrasound scan, which is 50% cheaper than individual scans.

2. Typ  the date of the next control visit is appointed during the test depending on its results

-  Type D within 1 week  to prevent Ligamentum teres ,which keeps the head in the acetabulum, starts to elongate and grow with each movement of the leg. It is an irreversible process - we are not able to shorten the elongated ligament nor the nerves or vessels inside  (going to epiphysis), that is why examination in neonatal unit is so crucial.

- Type IIa 4-6 weeks

-  type GN.  8 wweks

3. typ I the next control visit should take place at the age of 3 months.

Treatment according to Graf’s method consists of the following three stages: reposition, immobilisation, and reconstruction. Reposition is performed on instable types of hip: II c instable, D, IIIa/b, IV. If this cannot be done manually, we use an overhead traction appliance. 
In newborns within the first week of life, we have no difficulty inserting the head into the acetabulum. After reposition, we need to keep the hip in this position to keep the head deep in the acetabulum until the loose capsule shrinks and hip stability is restored. According to Graf’s method, hip instability is treated with the use of a plaster cast, where the legs are bent >90° and up to 50° in abduction. The plaster reaches to the knees only, which allows for rotational movements to furrow the bottom of the acetabulum. Depending on the size of the baby, we change the plaster every 2-4 weeks. When treating hip instability with the use of different kinds of orthopaedic braces, we examine the hip every week until the hip achieves clinical stability and stability in an ultrasonography test. Afterwards, we examine the hip less frequently, i.e. every 4 weeks. The progress of treatment is examined clinically and through ultrasonography. If we have any doubt, an X-ray test is used. This kind of treatment is effective and practical and does not result in femur head necrosis. This allows us to proceed to the next stage of treatment. The roof of the acetabulum is reconstructed with the use of orthopaedic braces. This method of treatment is used in the case of stable type of hip joint: IIa-, Ilb and Ilc in newborns. The legs are positioned very much like when a plaster cast is used. The bone acetabulum is reconstructed only without pressure on the head. Therefore, bending in excess of 90° is necessary and an abduction of minimum 45° to the shrinkage angle prevents damage to the femur head. The treatment is considered complete when we achieve the type I correct hip. 
The results of the treatment are checked with the use of ultrasonography, clinically and using X-ray testing (If there is no improvement, the use of a plaster cast is treatment of choice). Afterwards, we examine the joints every 2-3 months until the baby reaches the age of one. Then another X-ray is taken. Subsequent follow-ups take place every three years until the patient reaches the age of 18, when the construction of the joint is complete. This is done to ensure there is not even the slightest irregularity in the structure of the hip joint.

In the model orthopaedic centre of prof.R.Graf in Stolzalpe not a single operation has been carried since the introduction of the method and the last  artrogarphy was performed 20 years ago. In other centres in different  countries modeled on the Stolzalpe Hospital the results are comparable but only in those hospitals where orthopaedics perform  examinations personally .Operations occur only as a result of medical mistake or failure to appear at the obligatory control examination,or neuromuscular disorder.