Chondro-osseous border in baby hip ultrasonography for developmental dysplasia of the hip: an indispensable litmus paper for the accuracy of scientific publications

Purpose: The aim of our study was to use the chondro-osseous border (COB) as an indispensable assessment criterion to evaluate the quality of baby hip ultrasonography (US) images in the literature pertaining to the application of Graf’s technique. Materials and methods: Our literature review search yielded 144 articles. Of these, 41 contained images that were stated to be based on the application of Graf’s technique. Two reviewers, a radiologist and an orthopaedic surgeon, both course instructors for the use of baby hip US for developmental dysplasia of the hip (DDH), independently evaluated the articles to assess the diagnostic validity of the published images on the basis of a single criterion: the identification of the COB. Results: Of the 41 articles which were analyzed, 15 contained images without a COB, which corresponds to 36% (roughly, one out of three). Articles from countries where universal screening is performed (Germany, Italy, Switzerland, Mongolia) were all correct. All the articles from Turkey, a country which has made significant contribution with published material about Graf’s technique over many years, and most of the articles from China (80%), where Graf’s technique has become popular in recent years, contained correct images. Conclusion: Published literature lacks strict criteria for the publication of correct images corresponding to Graf’s technique in baby hip US. This fact raises concerns about the quality of published material (and, as a corollary, the quality of clinical application of the technique) and should have ramifications on scientific journal policies regarding the publication of such manuscripts.