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Classification systems in the Paediatric Hip

Classification of DDH
A. Static - Graf Classification (1984)

  • mid-coronal scan of hip joint. The straight line of the ilium must be viewed to ensure that the scan plane is through the centre of the acetabulum. See Picture.
  • Alpha angle = between line of ilium & bony acetabulum
  • Beta angle (less important) = between line of ilium & anterior labrum

Graf Classification (1984):

TypeAlpha angleDescription
1> 60 oNormal
243-59 oDelayed ossification in a child > 3 months, Physiological if < 3 months
33 < 43 oDislocated
44 < 43 oDislocated & labrum interposing betw. head & acetabulum

AVN in DDH

Classified by Kalamchi and Macewen

  1. Changes affecting the Ossific Nucleus:-
    • Initial delay / fragmentation of the ossific nucleus
    • Head in head appearance - good prognosis
  2. Lateral Physeal damage:-
    • Initial damage leads to a valgus deformity
  3. Central physeal damage
    • Short femoral neck with overgrowth of the GT
    • Leg length discrepancy
  4. Total damage to head and Physis:-
    • Varus, flat, Coxa magna
    • Early OA


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