{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T06:13:41Z","timestamp":1790921621171,"version":"4.1.0"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T00:00:00Z","timestamp":1616025600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>The purpose of this study was to identify imaging risk factors on contrast-enhanced hip MRI after closed reduction of developmental dysplasia of the hip (DDH) that could predict future development of avascular necrosis (AVN) of the femoral head.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>Fifty-eight infants (F: M = 53: 5, aged 3\u201318 months) who underwent immediate postoperative contrast-enhanced hip MRI after closed reduction of DDH were included in this study. Quality of reduction (concentric vs eccentric reduction with or without obstacles), abduction angle of the hip, presence of ossific nucleus, and pattern of contrast enhancement of the femoral head were retrospectively evaluated on MRI. Interobserver agreement of contrast enhancement pattern on MRI were evaluated by two radiologists. Development of AVN was determined through radiographic findings at 1 year after reduction.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>AVN of the femoral head developed in 13 (22%) of 58 patients. Excessive abduction of the hip joint (OR 4.65, [95% CI 1.20, 18.06] and global decreased enhancement of the femoral head (OR 71.66, [95% CI 10.54, 487.31]) exhibited statistically significant differences between the AVN and non-AVN groups (P &lt; 0.05). Eccentric reduction (P = 0.320) did not show statistically significant difference between two groups and invisible ossific nucleus (P = 0.05) showed borderline significance. Multi-variable logistic regression indicated that global decreased enhancement of the femoral head was a significant risk factor of AVN (OR 27.92, 95% CI [4.17, 350.18]) (P = 0.0031). Interobserver agreement of contrast enhancement pattern analysis and diagnosis of AVN were good (0.66, 95% CI [0.52, 0.80]).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Contrast-enhanced hip MRI provides accurate anatomical assessment of the hip after closed reduction of DDH. Global decreased enhancement of the femoral head could be used as a good predictor for future development of AVN after closed reduction of DDH.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0248701","type":"journal-article","created":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T17:45:22Z","timestamp":1616089522000},"page":"e0248701","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["MRI risk factors for development of avascular necrosis after closed reduction of developmental dysplasia of the hip: Predictive value of contrast-enhanced MRI"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1479-2064","authenticated-orcid":true,"given":"Jung-Eun","family":"Cheon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Young","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Hun","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woo Sun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae-Joon","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5225-1440","authenticated-orcid":true,"given":"Won Joon","family":"Yoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,3,18]]},"reference":[{"issue":"2","key":"pone.0248701.ref001","first-page":"82","article-title":"Closed reduction for treatment of development dysplasia of the hip in children","volume":"36","author":"T Murray","year":"2007","journal-title":"Am J Orthop (Belle Mead NJ)."},{"issue":"6","key":"pone.0248701.ref002","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1097\/01241398-199511000-00008","article-title":"Closed reduction of developmental dislocation of the hip in children older than 18 months","volume":"15","author":"PL Schoenecker","year":"1995","journal-title":"J Pediatr Orthop"},{"issue":"1","key":"pone.0248701.ref003","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/s00264-017-3685-x","article-title":"Long-term results of closed reduction for developmental dislocation of the hip in children of walking age under eighteen months old.","volume":"42","author":"SM Cha","year":"2018","journal-title":"Int Orthop"},{"issue":"29","key":"pone.0248701.ref004","doi-asserted-by":"crossref","first-page":"e4276","DOI":"10.1097\/MD.0000000000004276","article-title":"Association between open or closed reduction and avascular necrosis in developmental dysplasia of the hip: A PRISMA-compliant meta-analysis of observational studies.","volume":"95","author":"YJ Wang","year":"2016","journal-title":"Medicine (Baltimore)."},{"issue":"6","key":"pone.0248701.ref005","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1007\/s11832-013-0538-z","article-title":"Correlation between avascular necrosis and the presence of the ossific nucleus when treating developmental dysplasia of the hip.","volume":"7","author":"S Sllamniku","year":"2013","journal-title":"J Child Orthop"},{"issue":"7","key":"pone.0248701.ref006","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.2106\/00004623-199072070-00014","article-title":"Avascular necrosis in patients treated with the Pavlik harness for congenital dislocation of the hip","volume":"72","author":"S Suzuki","year":"1990","journal-title":"J Bone Joint Surg Am"},{"issue":"4","key":"pone.0248701.ref007","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1302\/0301-620X.72B4.2380203","article-title":"Avascular necrosis following closed reduction of congenital dislocation of the hip. 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