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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 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