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longitudinal traction should be applied along the axis of the femur and the
femoral head gently manipulated back into the acetabulum. If closed reduction is
unsuccessful, open reduction is necessary. During the dislocation, the posterior
labrum and joint capsule may detach, and then become trapped in the joint space
during reduction (spontaneous or closed). CT or MRI may be necessary to
evaluate the adequacy of reduction if instability or joint space widening is noted,
and in adolescent patients.
Proximal femoral physeal fractures . Fractures through the proximal femoral
physis can have a range of displacement from minimal to complete ( Fig. 111.36
). Unfortunately, there is a very high risk for osteonecrosis and subsequent longterm disability for completely displaced fractures. Urgent orthopedic consultation
should be obtained for surgical reduction and internal fixation. Minimally
displaced fractures in children less than 2 years may be treated with closed
reduction and casting.

FIGURE 111.36 Displaced Salter–Harris type I fracture of the left proximal femur in a 2-yearold boy (large arrow ). Also seen are fractures of the right pubic rami (small arrows ). The
pelvis is also disrupted posteriorly.

Femoral neck fractures . Displaced femoral neck fractures are uncommon in
children, but when they occur, they are considered an orthopedic emergency (
Fig. 111.37 ). Open or closed reduction is required for treatment of these