{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T09:55:37Z","timestamp":1773827737994,"version":"3.50.1"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2022,5,12]],"date-time":"2022-05-12T00:00:00Z","timestamp":1652313600000},"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:p>This study aimed to evaluate the relevant factors of postoperative avascular necrosis of the femoral head (AVN) in children with femoral neck fracture. This study retrospectively analyzed the clinical data of 28 children with femoral neck fractures treated at our center between July 2016 and January 2019. The average age was 9.3 (range, 4.4\u201314) years with 75% male participants. Fracture classification was based on the Delbet classification: there were four, seven, 15, and two cases of type I, II, III, and IV fractures, respectively. Displacement degree was based on the Garden classification. Sixteen cases had insignificant displacement (Garden types I and II), six had medium displacement (Garden type III), and six had significant displacement (Garden type IV). There were six early (\u226424 hours) and 22 delayed (&gt;24 hours) surgeries. Twenty-three patients had satisfactory reduction, and five had unsatisfactory reduction. The mean postoperative follow-up period was 15.7 (range, 12\u201336) months. Follow-up was evaluated using the Ratliff scoring standards. The correlation between age, fracture classification, displacement degree, surgery timing, reduction quality, and other factors and AVN occurrence was statistically analyzed. Among 28 children, AVN was found in six cases. There were statistically significant differences in displacement degree (P = 0.001) and reduction quality (P = 0.001), while the occurrence of AVN did not significantly differ with sex (P = 0.117), age distribution (P = 0.218), fracture classification (P = 0.438), surgery timing (P = 0.255), and mechanism of injury (P = 0.436). The results of logistic regression analysis showed that displacement degree was a relevant risk factor (P = 0.049, odds ratio [OR] = 8.391, 95% confidence interval [CI]: 1.004\u221270.117), while reduction quality was not (P = 0.075, OR = 14.536, 95% CI: 0.757\u2212278.928). Although the development of AVN in children with femoral neck fractures may be related to many factors, the results of this research suggest that there is a significant correlation between displacement degree and AVN occurrence.<\/jats:p>","DOI":"10.1371\/journal.pone.0268058","type":"journal-article","created":{"date-parts":[[2022,5,12]],"date-time":"2022-05-12T17:34:29Z","timestamp":1652376869000},"page":"e0268058","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["Postoperative avascular necrosis of the femoral head in pediatric femoral neck fractures"],"prefix":"10.1371","volume":"17","author":[{"given":"Yang","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dong","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9892-2649","authenticated-orcid":true,"given":"Kelai","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingwei","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhe","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,5,12]]},"reference":[{"key":"pone.0268058.ref001","doi-asserted-by":"crossref","first-page":"302","DOI":"10.4055\/cios.2011.3.4.302","article-title":"Pediatric femoral neck fractures: our 10 years of experience","volume":"3","author":"K Bali","year":"2011","journal-title":"Clin Orthop Surg"},{"key":"pone.0268058.ref002","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/BPO.0000000000000424","article-title":"Osteonecrosis after femoral neck fractures in children and adolescents: analysis of risk factors","volume":"36","author":"D Spence","year":"2016","journal-title":"J Pediatr Orthop"},{"key":"pone.0268058.ref003","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/00005131-200605000-00005","article-title":"Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases","volume":"20","author":"ES Moon","year":"2006","journal-title":"J Orthop Trauma"},{"key":"pone.0268058.ref004","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1302\/0301-620X.95B1.30161","article-title":"Factors affecting the outcome of fractures of the femoral neck in children and adolescents: a systematic review","author":"M Yeranosian","year":"2013","journal-title":"Bone Joint J"},{"key":"pone.0268058.ref005","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1007\/s00264-010-1039-z","article-title":"Fractures of the head and neck of the femur in children: an outcome study","volume":"35","author":"S Hajdu","year":"2011","journal-title":"Int Orthop"},{"key":"pone.0268058.ref006","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1097\/00000658-192811000-00012","article-title":"Fracture of the neck of the femur in childhood: a report of six cases","volume":"88","author":"PC Colonna","year":"1928","journal-title":"Ann Surg"},{"key":"pone.0268058.ref007","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1097\/BPB.0b013e32832d5d5f","article-title":"Complication rate after operative treatment of paediatric femoral neck fractures","volume":"18","author":"M Nayeemuddin","year":"2009","journal-title":"J Pediatr Orthop B"},{"key":"pone.0268058.ref008","doi-asserted-by":"crossref","first-page":"515","DOI":"10.5435\/JAAOS-D-15-00237","article-title":"Hip vascularity: a review of the anatomy and clinical implications","volume":"24","author":"MA Seeley","year":"2016","journal-title":"J Am Acad Orthop Surg"},{"key":"pone.0268058.ref009","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1302\/0301-620X.82B5.0820679","article-title":"Anatomy of the medial femoral circumflex artery and its surgical implications","volume":"82","author":"E Gautier","year":"2000","journal-title":"J Bone Joint Surg Br"},{"key":"pone.0268058.ref010","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/01.blo.0000238794.82466.3d","article-title":"Femoral neck fractures in pediatric patients: 30 years experience at a level 1 trauma center","volume":"454","author":"MW Shrader","year":"2007","journal-title":"Clin Orthop Relat Res"},{"key":"pone.0268058.ref011","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/01.blo.0000155372.65446.40","article-title":"Pediatric fractures and dislocations of the hip and pelvis","volume":"432","author":"TJ Quick","year":"2005","journal-title":"Clin Orthop Relat Res"},{"key":"pone.0268058.ref012","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1007\/s00264-018-3998-4","article-title":"Early versus late treatment of paediatric femoral neck fractures: a systematic review and meta-analysis","volume":"43","author":"N AlKhatib","year":"2019","journal-title":"Int Orthop"},{"key":"pone.0268058.ref013","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1302\/0301-620X.101B9.BJJ-2019-0275.R1","article-title":"Risk factors for the development of avascular necrosis after femoral neck fractures in children: a review of 239 cases","author":"WT Wang","year":"2019","journal-title":"Bone Joint J"},{"key":"pone.0268058.ref014","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S0020-1383(00)00109-1","article-title":"Complications of fracture of the neck of the femur in children. A long-term follow-up study","volume":"32","author":"HA Morsy","year":"2001","journal-title":"Injury"},{"key":"pone.0268058.ref015","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.injury.2004.04.010","article-title":"Fractures of the femoral neck in children: long-term follow-up in 62 hip fractures","volume":"36","author":"E Togrul","year":"2005","journal-title":"Injury"},{"key":"pone.0268058.ref016","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1302\/0301-620X.84B1.0840108","article-title":"Displaced fractures of the hip in children. Management by early operation and immobilisation in a hip spica cast","volume":"84","author":"JM Flynn","year":"2002","journal-title":"J Bone Joint Surg Br"},{"key":"pone.0268058.ref017","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1007\/s00264-015-2677-y","article-title":"Treatment analysis of paediatric femoral neck fractures: a prospective multicenter therapueutic study in Indian scenario","volume":"39","author":"R Panigrahi","year":"2015","journal-title":"Int Orthop"},{"key":"pone.0268058.ref018","first-page":"300","article-title":"Final results of the operatively treated femoral neck fractures in children and adolescents","volume":"75","author":"G Sok\u00f3\u0142","year":"2010","journal-title":"Chir Narzadow Ruchu Ortop Pol"},{"key":"pone.0268058.ref019","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.otsr.2009.11.007","article-title":"Displaced femoral neck fractures in children: are complications predictable?","volume":"96","author":"MA Dendane","year":"2010","journal-title":"Orthop Traumatol Surg Res"},{"key":"pone.0268058.ref020","doi-asserted-by":"crossref","first-page":"S44","DOI":"10.1016\/j.injury.2015.10.059","article-title":"Femoral neck fractures in children and the role of early hip decompression in final outcome","volume":"466","author":"B Bukva","year":"2015","journal-title":"Injury"},{"key":"pone.0268058.ref021","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1111\/os.12629","article-title":"Poor outcomes of children and adolescents with femoral neck fractures: a meta-analysis based on clinical studies","volume":"12","author":"Y Chen","year":"2020","journal-title":"Orthop Surg"},{"key":"pone.0268058.ref022","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1302\/0301-620X.46B4.630","article-title":"Stability and union in subcapital fractures of the femur","volume":"46","author":"RS Garden","year":"1964","journal-title":"J Bone Joint Surg Br"},{"key":"pone.0268058.ref023","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.2106\/00004623-200408000-00015","article-title":"Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years","volume":"86","author":"GJ Haidukewych","year":"2004","journal-title":"J Bone Joint Surg Am"},{"key":"pone.0268058.ref024","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1302\/0301-620X.44B3.528","article-title":"Fractures of the neck of the femur in children","author":"AH Ratliff","year":"1962","journal-title":"J Bone Joint Surg Br"},{"key":"pone.0268058.ref025","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s00776-004-0875-3","article-title":"Displaced femoral neck fracture in children and adolescents: closed versus open reduction\u2014a preliminary study","volume":"10","author":"IK Dhammi","year":"2005","journal-title":"J Orthop Sci"},{"key":"pone.0268058.ref026","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1302\/0301-620X.92B8.24482","article-title":"Displaced fracture of the femoral neck in children: open versus closed reduction","volume":"92","author":"KS Song","year":"2010","journal-title":"J Bone Joint Surg Br"},{"key":"pone.0268058.ref027","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1097\/BPB.0000000000000339","article-title":"Delayed treatment of femoral neck fractures in 58 children: open reduction internal fixation versus closed reduction internal fixation","volume":"25","author":"L Ju","year":"2016","journal-title":"J Pediatr Orthop B"},{"key":"pone.0268058.ref028","doi-asserted-by":"crossref","first-page":"S40","DOI":"10.1016\/j.injury.2019.01.043","article-title":"Surgical treatment with cannulated screws for pediatric femoral neck fractures: a case series","volume":"502","author":"V Pavone","year":"2019","journal-title":"Injury"},{"key":"pone.0268058.ref029","doi-asserted-by":"crossref","first-page":"e79","DOI":"10.2106\/JBJS.J.01714","article-title":"Physeal bar excision: a case report with a forty-two-year follow-up","volume":"93","author":"HA Peterson","year":"2011","journal-title":"J Bone Joint Surg Am"},{"key":"pone.0268058.ref030","doi-asserted-by":"crossref","first-page":"961","DOI":"10.2106\/00004623-197658070-00011","article-title":"The arterial supply of the developing proximal end of the human femur","volume":"58","author":"SM Chung","year":"1976","journal-title":"J Bone Joint Surg Am"},{"key":"pone.0268058.ref031","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1302\/0301-620X.39B2.358","article-title":"The normal vascular anatomy of the human femoral head during growth","author":"J. Trueta","year":"1957","journal-title":"J Bone Joint Surg Br"},{"key":"pone.0268058.ref032","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1097\/00005373-198604000-00013","article-title":"Displaced hip fractures in children and adolescents","volume":"26","author":"MF Swiontkowski","year":"1986","journal-title":"J Trauma"},{"key":"pone.0268058.ref033","doi-asserted-by":"crossref","first-page":"283","DOI":"10.2106\/00004623-199402000-00019","article-title":"Fractures of the head and neck of the femur in children","volume":"76","author":"LO Hughes","year":"1994","journal-title":"J Bone Joint Surg Am"},{"key":"pone.0268058.ref034","doi-asserted-by":"crossref","first-page":"431","DOI":"10.2106\/00004623-197759040-00001","article-title":"Fracture of the neck and intertrochanteric region of the femur in children","volume":"59","author":"ST Canale","year":"1977","journal-title":"J Bone Joint Surg Am"},{"key":"pone.0268058.ref035","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.2106\/00004623-197153060-00013","article-title":"Fractures of the neck of the femur in children","volume":"53","author":"SF Lam","year":"1971","journal-title":"J Bone Joint Surg Am"},{"key":"pone.0268058.ref036","doi-asserted-by":"crossref","first-page":"91","DOI":"10.3109\/17453678008990774","article-title":"Fractures of the hip in children and adolescents","volume":"51","author":"W Pf\u00f6rringer","year":"1980","journal-title":"Acta Orthop Scand"},{"key":"pone.0268058.ref037","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1097\/01241398-199203000-00004","article-title":"Transepiphyseal fractures of the neck of the femur in very young children","volume":"12","author":"E Forlin","year":"1992","journal-title":"J Pediatr Orthop"},{"key":"pone.0268058.ref038","doi-asserted-by":"crossref","first-page":"361","DOI":"10.3928\/0147-7447-19890301-05","article-title":"Hip fractures in children. A long-term follow up of 17 cases","volume":"12","author":"O Ovesen","year":"1989","journal-title":"Orthopedics"},{"key":"pone.0268058.ref039","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.arth.2020.07.046","article-title":"A study on the evaluation of a risk score of osteonecrosis of the femoral head based on survival analysis","volume":"36","author":"J Zheng","year":"2021","journal-title":"J Arthroplasty"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0268058","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,12]],"date-time":"2022-05-12T17:35:09Z","timestamp":1652376909000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0268058"}},"subtitle":[],"editor":[{"given":"Wen-Jun","family":"Tu","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,5,12]]},"references-count":39,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0268058","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,12]]}}}