Developmental Dysplasia of HIP (D.D.H.)

This was a 10 day old infant not moving the left lower limb with tenderness on left hip movement passively . Clinical suspicion was developmental dysplasia of hip and was referred for a scan .

please visit the following site for good line diagrams.

infant hip 1

infant hip 2

The following images were secured .

This was diagnosed as type II C  of Graf

alpha angle was 45.5

alpha angle was 45.5

the next picture is the normal right hip for comparison

right hip for comparison .alpha angle is 54.6- normal

right hip for comparison .
alpha angle is 54.6- normal

transverse view

transverse view


Kindly visit the following link for a brief info on Graf  classification ;  .

Graf proposed an ultrasound classification system for infant hips (see Developmental Dysplasia of the Hip (DDH) ) combining both alpha and beta angles. There are a number of additional subdivisions, which are often not used clinically.

As a general rule, the alpha angle determines the type and in some instances the beta angle is used to determine subtype.

  • type I alpha angle > 60 degrees  (normal)
    • type Ia : beta angle < 55 degrees
    • type Ib : beta angle > 55 degrees
  • type II
    • type IIa : alpha angle 50 – 59 degrees
    • type IIb : alpha angle 50 – 59 degrees
    • type IIc
      • alpha angle 43 – 49 degrees
      • beta angle < 77 degrees
  • type D (“about to decenter”)
    • alpha angle 43 – 49 degrees
    • beta angle > 77 degrees
  • type III : alpha angle < 43 degrees
    • type IIIa and IIIb distinguished on the grounds of structural alteration of the cartilaginous roof
  • type IV
    • alpha angle < 43 degrees
    • dislocated with labrum interposed between femoral head and acetabulum

In the Graf method, with the infant in a lateral decubitus position, coronal images of the hip joint are obtained, and α and β angles are measured. Mature hips are defined as those having an α angle of 60 degrees or greater, and are classified as types Ia or Ib, depending on the β angle. Hips with an α angle of 50 to 59 degrees are defined as immature, and are classified as types IIa or IIb, depending on the infant’s age. Hips with an α angle of 49 degrees or less are defined as having pathological development, and are classified as types IIc, D, IIIa, IIIb, or IV

If evidence of instability is present, a Pavlik harness should be considered and, if used, fitted appropriately

11 thoughts on “Developmental Dysplasia of HIP (D.D.H.)

  1. Excellent post! In my practice we use the Graf method exclusively. Things have come a long way since my B-scan days. Your examples here are fantastic.


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