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The aim of this study was to evaluate whether breech presentation in twins is associated with abnormal hip ultrasound findings and to assess the influence of delivery mode, sex and gestational age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Obstetric and ultrasound data from twin births at Frankfurt University Hospital between 2010 and 2014 were retrospectively analyzed. A\u00a0total of 130 twins in whom at least 1\u00a0infant with breech presentation and both infants underwent hip ultrasound according to Graf\u2019s technique within the first 14\u00a0days after birth were included. Twins were divided into breech-breech, breech-vertex and breech-transverse groups. Hip findings were categorized as normal (Graf type\u00a0Ia\/Ib) or abnormal\/immature (Graf type\u00a0IIa or higher). Statistical analysis was performed using Fisher-Freeman-Halton exact testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      No infant demonstrated manifest DDH (Graf type\u00a0IIc or higher). Overall, 5.4% of infants showed physiologically immature or abnormal hip ultrasound findings classified as Graf type\u00a0IIa. No significant association was found between breech presentation and abnormal hip findings; however, abnormal findings were more common in the breech-transverse group compared to the breech-breech group (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u20090.037). Infants delivered via cesarean section demonstrated a\u00a0higher rate of abnormal findings than vaginally delivered infants (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u20090.041).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this cohort, breech presentation in twins was not associated with an increased rate of abnormal hip ultrasound findings. The combination of breech and transverse presentation may represent a\u00a0higher risk constellation. Due to the retrospective design and lack of a\u00a0singleton control group, conclusions regarding a\u00a0modifying effect of twin pregnancy on the occurrence of DDH cannot be drawn.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>Retrospective cohort study. Level\u00a0III evidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00132-026-04867-0","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T12:31:57Z","timestamp":1784032317000},"page":"727-731","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between breech presentation in twins and developmental dysplasia of the hip","Zusammenhang zwischen Stei\u00dflage bei Zwillingen und H\u00fcftdysplasie"],"prefix":"10.1007","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8319-6773","authenticated-orcid":false,"given":"Beatrice","family":"Jung","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Hollfelder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"zur Strassen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Bodelle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Schulz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"4867_CR1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-22034-0","volume-title":"Ultraschalldiagnostik der S\u00e4uglingsh\u00fcfte. 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Informed consent was obtained from all individual participants included in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}}]}}