{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T08:29:16Z","timestamp":1786609756400,"version":"build-2736575974"},"reference-count":26,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T00:00:00Z","timestamp":1786233600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["HIP International"],"abstract":"<jats:sec>\n                    <jats:title>Background and objectives:<\/jats:title>\n                    <jats:p>Paediatric femoral neck fractures (PFNFs) are rare but carry a significant risk of avascular necrosis (AVN) of the femoral head. Delbet type II fractures are the most common variant, yet specific predictors of AVN within this subgroup remain unclear. This study aimed to identify risk factors for AVN in Delbet type II PFNFs and evaluate the functional outcomes following management with weight-bearing restriction and bisphosphonate therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective case-control study conducted from June 2011 to May 2022 included a total of 15 Delbet type II fractures. 5 patients who developed AVN (cases) were matched in a 1:2 ratio with 10 patients who did not develop AVN (controls).\u2009Quality of reduction was quantified using the neck-shaft angle (AP view) and Southwick angle (lateral view). Functional outcomes were evaluated at final follow-up (mean 35.2\u2009months) using the Ratliff criteria and modified Harris Hip Score (mHHS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      An increased Southwick angle was significantly associated with AVN (mean 14.8\u00b0 vs. 5.95\u00b0,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.012; OR 1.30, 95% CI, 1.01\u20131.68). Age &gt;7\u2009years and non-anatomic reduction showed high odds ratios (OR 6.00), but did not achieve statistical significance. Reduction method, type of fixation and injury-surgery interval were not significantly associated with AVN. 4 out of 5 AVN cases achieved good functional outcomes, and 1 achieved a fair outcome following a 12-month regimen of oral bisphosphonates and restricted weight-bearing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>An increased Southwick angle following fracture reduction is a significant predictor of AVN in Delbet type II PFNFs, emphasising the critical importance of achieving anatomical reduction in the sagittal plane. If AVN develops, conservative management with oral bisphosphonates and protected weight-bearing yields favourable functional outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11207000261471457","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T05:42:25Z","timestamp":1786340545000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors for avascular necrosis in Delbet type II paediatric femoral neck fractures: a case-control study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0208-5653","authenticated-orcid":false,"given":"Nirmal R","family":"Gopinathan","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, PostGraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4227-526X","authenticated-orcid":false,"given":"Akash K","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, PostGraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5858-8113","authenticated-orcid":false,"given":"Jai P","family":"Khatri","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, PostGraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4620-723X","authenticated-orcid":false,"given":"Karthick","family":"Rangasamy","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, PostGraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8768-7121","authenticated-orcid":false,"given":"Vivek P","family":"Ksheerasagar","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, PostGraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pebam","family":"Sudesh","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, PostGraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,9]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.4103\/ortho.IJOrtho_404_17"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-200605000-00005"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000000424"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-025-06423-6"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-023-03502-4"},{"key":"e_1_3_2_7_2","article-title":"Risk factors for avascular necrosis of the femoral head in pediatric femoral neck fractures","volume":"13","author":"Chaudhary S","year":"2021","unstructured":"Chaudhary S, Garg V, Mishra D, et al. Risk factors for avascular necrosis of the femoral head in pediatric femoral neck fractures. Cureus 2021; 13: e16776.","journal-title":"Cureus"},{"key":"e_1_3_2_8_2","first-page":"107","article-title":"Can formation of avascular necrosis really be prevented in Delbet type 2 femoral neck fractures?","volume":"28","author":"Akar MS","year":"2022","unstructured":"Akar MS, Yi\u011fit \u015e. Can formation of avascular necrosis really be prevented in Delbet type 2 femoral neck fractures? Ulus Travma Acil Cerrahi Derg 2022; 28: 107\u2013112.","journal-title":"Ulus Travma Acil Cerrahi Derg"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0030-5898(20)31041-5"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.44B3.528"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcot.2017.11.019"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-019-04429-4"},{"key":"e_1_3_2_13_2","article-title":"Postoperative avascular necrosis of the femoral head in pediatric femoral neck fractures","volume":"17","author":"Li Y","year":"2022","unstructured":"Li Y, Sun D, Wang K, et al. Postoperative avascular necrosis of the femoral head in pediatric femoral neck fractures. PLoS One 2022; 17: e0268058.","journal-title":"PLoS One"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.95B1.30161"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2024.111829"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000000226"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-018-3998-4"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2009.11.007"},{"key":"e_1_3_2_19_2","first-page":"219","article-title":"Complications associated with surgically treated hip fractures in children","volume":"11","author":"Erdem Bagatur A","year":"2002","unstructured":"Erdem Bagatur A, Zorer G. Complications associated with surgically treated hip fractures in children. J Pediatr Orthop B 2002; 11: 219\u2013228.","journal-title":"J Pediatr Orthop B"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20151020-06"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000238794.82466.3d"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-200109000-00021"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e318277172e"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200105000-00014"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.00964"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1302\/1863-2548.12.170141"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200503000-00011"}],"container-title":["HIP International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11207000261471457","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/11207000261471457","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11207000261471457","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T07:50:39Z","timestamp":1786607439000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/11207000261471457"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,9]]},"references-count":26,"alternative-id":["10.1177\/11207000261471457"],"URL":"https:\/\/doi.org\/10.1177\/11207000261471457","relation":{},"ISSN":["1120-7000","1724-6067"],"issn-type":[{"value":"1120-7000","type":"print"},{"value":"1724-6067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,9]]},"article-number":"11207000261471457"}}