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Ultrasound for DDH

- See: DDH

- Discussion:
    - ultrasound allows description of the morphology of the acetabulum and the stability of the joint (dynamic examination);
    - ultrasound becomes less useful after 6 months of age because of progressive ossification of the femoral head;
    - joint stability:
          - femoral and acetabulum are evaluated while performing provative tests (Barlow maneuver);
          - transducer is placed over the femoral head transverse to the pelvis while the hip is flexed and a Barlow maneuver applied;
    - morphology:
          - describes the cartilaginous and osseous anatomy of the acetabulum (noting depth and shape);
          - Graf classification:
               - coronal plane is imaged by placing the transducer over the lateral aspect of the hip;
               - type I: normal hip:
               - type II < 3 mo physiologic immaturity and > 3 mo mild dysplasia:
                     - type II hip is immature or mildly dysplastic and has a more shallow acetabulum with a round rim;
                     - in children younger than 3 months, most of these will spontaneously resolve;
                     - in children older than age 3 months, the deformity is expected to persist without treatment;
               - type III: dislocation
                     - acetabulum is shallow;
                     - cartilaginous roof is displaced with eversion of labrum;
               - type IV: high dislocation
                     - acetabular cup is flat and has the worse prognosis;
                     - femoral head is laterally and superiorly displaced;
                     - labrum is interposed between the femoral head and the lateral wall of the ilium

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