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): | Type | Alpha angle | Description | | 1 | > 60 o | Normal | | 2 | 43-59 o | Delayed ossification in a child > 3 months, Physiological if < 3 months | | 3 | 3 < 43 o | Dislocated | | 4 | 4 < 43 o | Dislocated & labrum interposing betw. head & acetabulum |
AVN in DDH
Classified by Kalamchi and Macewen - Changes affecting the Ossific Nucleus:-
- Initial delay / fragmentation of the ossific nucleus
- Head in head appearance - good prognosis
- Lateral Physeal damage:-
- Initial damage leads to a valgus deformity
- Central physeal damage
- Short femoral neck with overgrowth of the GT
- Leg length discrepancy
- Total damage to head and Physis:-
- Varus, flat, Coxa magna
- Early OA
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