This study evaluated the effect of limb lengthening on longitudinal growth in patients with achondroplasia. Growth of the lower extremity was assessed retrospectively by serial radiographs in 35 skeletally immature patients with achondroplasia who underwent bilateral limb lengthening (Group 1), and in 12 skeletally immature patients with achondroplasia who did not (Group 2). In Group 1, 23 patients underwent only tibial lengthening (Group 1a) and 12 patients underwent tibial and femoral lengthening sequentially (Group 1b). The mean lengthening in the tibia was 9.2 cm (59.5%) in Group 1a, and 9.0 cm (58.2%) in the tibia and 10.2 cm (54.3%) in the femur in Group 1b. The mean follow-up was 9.3 years (8.6 to 10.3). The final mean total length of lower extremity in Group 1a was 526.6 mm (501.3 to 552.9) at the time of skeletal maturity and 610.1 mm (577.6 to 638.6) in Group 1b, compared with 457.0 mm (411.7 to 502.3) in Group 2. However, the mean actual length, representing the length solely grown from the physis without the length of distraction, showed that there was a significant disturbance of growth after limb lengthening. In Group 1a, a mean decrease of 22.4 mm (21.3 to 23.1) (4.9%) was observed in the actual limb length when compared with Group 2, and a greater mean decrease of 38.9 mm (37.2 to 40.8) (8.5%) was observed in Group 1b when compared with Group 2 at skeletal maturity. In Group 1, the mean actual limb length was 16.5 mm (15.8 to 17.2) (3.6%) shorter in Group 1b when compared with Group 1a at the time of skeletal maturity. Premature physeal closure was seen mostly in the proximal tibia and the distal femur with relative preservation of proximal femur and distal tibia. We suggest that significant disturbance of growth can occur after extensive limb lengthening in patients with achondroplasia, and therefore, this should be included in pre-operative counselling of these patients and their parents

Salter-Harris II fractures of the distal tibia affect children frequently, and when they are displaced present a treatment dilemma. Treatment primarily aims to restore alignment and prevent premature physeal closure, as this can lead to angular deformity, limb length difference, or both. Current literature is of poor methodological quality and is contradictory as to whether conservative or surgical management is superior in avoiding complications and adverse outcomes. A state of clinical equipoise exists regarding whether displaced distal tibial Salter-Harris II fractures in children should be treated with surgery to achieve anatomical reduction, or whether cast treatment alone will lead to a satisfactory outcome. Systematic review and meta-analysis has concluded that high-quality prospective multicentre research is needed to answer this question. The Outcomes of Displaced Distal tibial fractures: Surgery Or Casts in KidS (ODD SOCKS) trial, funded by the National Institute for Health and Care Research, aims to provide this high-quality research in order to answer this question, which has been identified as a top-five research priority by the British Society for Children’s Orthopaedic Surgery. Cite this article: Bone Joint J 2023;105-B(5):471–473

Purpose of study: A single dynamic hip screw is the recommended method of fixation for slipped upper femoral epiphysis (SUFE). Current practice favours placement of the screw in the centre of the femoral head on both anteroposterior and lateral planes. This study investigated screw placement in the femoral head for SUFE and the prevalence of AVN, chondrolysis, late slippage, and time to physeal closure. Method: Clinical notes and radiographs of 38 consecutive patients (61 hips), who underwent single screw fixation for SUFE, were evaluated retrospectively with a minimum follow up of 24 months (24–56). Two way ANOVA and post hoc tests were performed to analyse the correlation between the different variables and the outcome, at a 5% significance level. Results: There were 16 acute slips, 18 chronic slips and 10 acute on chronic slips. 17 slips were treated prophylactically. Mild slip was noted in 39 hips, moderate in 4 and severe in 1 hip. A central-central position was only achieved in 50% of cases. No significant difference between the time to physeal closure and the screw position was found. No late slippage, AVN or chondrolysis occurred in this series. Conclusions: Our results demonstrate that positions of the screw, other than in the centre of the femoral head, provide adequate stability. There is no correlation between screw position and the time to physeal closure, the risk of avascular necrosis or chondrolysis. We recommend that positions other than the “optimal central-central position” be accepted if not initially achieved, especially for mild SUFE. The potential hazards from several attempts to achieve the optimum position outweigh the benefits

Aims. The aim of this study was to investigate whether including the stages of ulnar physeal closure in Sanders stage 7 aids in a more accurate assessment for brace weaning in patients with adolescent idiopathic scoliosis (AIS). Methods. This was a retrospective analysis of patients who were weaned from their brace and reviewed between June 2016 and December 2018. Patients who weaned from their brace at Risser stage ≥ 4, had static standing height and arm span for at least six months, and were ≥ two years post-menarche were included. Skeletal maturity at weaning was assessed using Sanders staging with stage 7 subclassified into 7a, in which all phalangeal physes are fused and only the distal radial physis is open, with narrowing of the medial physeal plate of the distal ulna, and 7b, in which fusion of > 50% of the medial growth plate of distal ulna exists, as well as the distal radius and ulna (DRU) classification, an established skeletal maturity index which assesses skeletal maturation using finer stages of the distal radial and ulnar physes, from open to complete fusion. The grade of maturity at the time of weaning and any progression of the curve were analyzed using Fisher’s exact test, with Cramer’s V, and Goodman and Kruskal’s tau. Results. We studied a total of 179 patients with AIS, of whom 149 (83.2%) were female. Their mean age was 14.8 years (SD 1.1) and the mean Cobb angle was 34.6° (SD 7.7°) at the time of weaning. The mean follow-up was 3.4 years (SD 1.8). At six months after weaning, the rates of progression of the curve for patients weaning at Sanders stage 7a and 7b were 11.4% and 0%, respectively for those with curves of < 40°. Similarly, the rates of progression of the curve for those being weaned at ulnar grade 7 and 8 using the DRU classification were 13.5% and 0%, respectively. The use of Sanders stages 6, 7a, 7b, and 8 for the assessment of maturity at the time of weaning were strongly and significantly associated (Cramer’s V 0.326; p = 0.016) with whether the curve progressed at six months after weaning. Weaning at Sanders stage 7 with subclassification allowed 10.6% reduction of error in predicting the progression of the curve. Conclusion. The use of Sanders stages 7a and 7b allows the accurate assessment of skeletal maturity for guiding brace weaning in patients with AIS. Weaning at Sanders stage 7b, or at ulnar grade 8 with the DRU classification, is more appropriate as the curve did not progress in any patient with a curve of < 40° immediately post-weaning. Thus, reaching full fusion in both distal radial and ulnar physes (as at Sanders stage 8) is not necessary and this allows weaning from a brace to be initiated about nine months earlier. Cite this article: Bone Joint J 2021;103-B(1):141–147

Aim. With the link between obesity and Slipped Upper Femoral Epiphysis (SUFE) well established and a rising number of paediatric orthopaedic patients presenting with vitamin D deficiency, the aim of our study was to establish the incidence of vitamin D deficiency in SUFE patients and whether low vitamin D levels increases the time to proximal femoral physeal fusion post surgical fixation. Method. All paediatric patients presenting to the orthopaedic department at University Hospital Southampton with a SUFE and tested for vitamin D between June 2007 to present day and who were subsequently found to have low levels of vitamin D, were eligible for inclusion in the study. A deficient level of vitamin D (25-(OH)D) was determined as < 52 nmols/L and insufficiency between 52–72 nmols/L. Levels > 72 nmols/L were considered to be normal. The normal time for 50% of physeal fusion on anteroposterior radiograph quoted in the literature is 9 months. Results. This study includes a cohort of 28 patients and 45 hips. All of these patients were treated with pinning insitu. Eighty six per cent were found to be vitamin D deficient. The mean physeal closure for these patients post fixation, including those yet to fuse and which have exceeded 12 months, was 23 months (range 9–64 months). Conclusion. This study has shown a correlation between vitamin D deficiency and prolonged physeal closure in SUFE patients. With an increasing prevalence of vitamin D deficiency, it is recommended that all patients presenting with a SUFE, be tested for low vitamin D levels, so that early treatment with supplementation can be initiated

Fixation by a single screw is considered the current treatment of choice for a slipped capital femoral epiphysis. This approach promotes premature physeal closure. The use of a modified, standard, single, cannulated screw designed to maintain epiphyseal fixation without causing premature closure of the physis was reviewed in ten patients. The nine boys and one girl aged between 10.6 and 12.6 years with unilateral slipped capital femoral epiphysis (SCFE), were markedly skeletally immature (Tanner stage I, bone age 10 to 12.6 years). Clinical and radiological review at a mean follow-up of 44.3 months (36 to 76) showed no difference in the time to physeal closure between the involved and uninvolved side. Measurement of epiphyseal and physeal development showed continued growth and remodelling in all patients. Use of this device provided epiphyseal stability and maintained the capacity for physeal recovery and growth following treatment for both unstable and stable slipped capital femoral epiphysis

Purpose. The importance of femoral head-neck morphology in the development of early hip osteoarthritis is recognized in femeroacetabular impingement (FAI), however no studies have examined FAI morphology in the developing hip, i.e. pre-closure of the proximal femoral physis. We developed a pilot project to study prevalence of CAM-type FAI hip morphology in both the pre- and post-closure proximal femoral physes of asymptomatic children using MR-imaging. We also examined biologic markers possibly related to FAI etiology, including Vitamin D metabolites, BMI, family history, and activity levels. Method. Recruitment included volunteers with asymptomatic lower extremities, and either pre- or post-closure of the proximal femoral physis. Males were 10–12 years (pre-closure) or 15–18 years (post-closure); females were 8–10 years or 14 18 years. Phlebotomy and urine sampling were used to assess metabolic markers. MRI of bilateral hips and a clinical exam including hip impingement tests were conducted. MR imaging assessment was independent and blinded and recorded using established parameters including alpha angles measured at both the 3:00 (anterior head-neck junction) and 1:30 (antero-superior head-neck junction) radial image positions. Results. Fifty-two volunteers were recruited (32 boys, 20 girls), of whom 44 had bilateral hips imaged (88 hips). Radiographic analysis showed no CAM-type morphology in pre-closure hips and 14% in post-closure hips, using established criteria (alpha > 50.5). The difference between alpha angle measurements at 3:00 and 1:30 positions (5.16) appears significant in developing hips. Conclusion. Results confirm our ability to recruit a cohort of asymptomatic children for the proposed methodology. Collected data found FAI in 14% of the closed-physes group and 0 % in the open physes group suggesting possible physeal closure importance. The difference between 3:00 and 1:30 alpha angle measurements was significantly less than in published adult figures, further suggesting a developmental role in CAM-Type FAI. This is the first published attempt to assess CAM-type FAI morphology in the developing hip. Preliminary data suggests the period just prior to physeal closure may have significant etiological implications. New parameters for imaging angles are suggested. The study results will guide future cohort study designs

Patellar instability most frequently presents during adolescence. Congenital and infantile dislocation of the patella is a distinct entity from adolescent instability and measurable abnormalities may be present at birth. In the normal patellofemoral joint an increase in quadriceps angle and patellar height are matched by an increase in trochlear depth as the joint matures. Adolescent instability may herald a lifelong condition leading to chronic disability and arthritis. Restoring normal anatomy by trochleoplasty, tibial tubercle transfer or medial patellofemoral ligament (MPFL) reconstruction in the young adult prevents further instability. Although these techniques are proven in the young adult, they may cause growth arrest and deformity where the physis is open. A vigorous non-operative strategy may permit delay of surgery until growth is complete. Where non-operative treatment has failed a modified MPFL reconstruction may be performed to maintain stability until physeal closure permits anatomical reconstruction. If significant growth remains an extraosseous reconstruction of the MPFL may impart the lowest risk to the physis. If minor growth remains image intensifier guided placement of femoral intraosseous fixation may impart a small, but acceptable, risk to the physis. This paper presents and discusses the literature relating to adolescent instability and provides a framework for management of these patients. Cite this article: Bone Joint J 2017;99-B:159–70

Purposes:. See if permanent damage of the growth plate after physeal distraction is the rule and. Identify factors with influence on the viability of the physis after physeal distraction. Introduction: Surgeons have always been concerned about the fate of the growth plate after physeal distraction and for that reason this technique has usually been considered only in patients nearing maturity. Previous experimental work has shown that the velocity of distraction has an influence on the viability of the growth plate at follow-up (recommended rate: 0.5 mm/day). Clinically, it has also been our observation that the condition of the physis prior to distraction is another important factor related to physeal function in the long term. Patients and methods: Since 1987 we have used low velocity physeal distraction in 43 bone segments of which 37 cases have been followed-up at least for 24 months and this has been the group included in this study. The indications were lengthening (14), angular deformity correction (19) and resection of benign bone tumours (4). Most patients (24) were older than 10 y.o. and 22 of them were followed-up until maturity. We have retrospectively reviewed these patients looking at the radiological morphology and function of the distracted growth plate at follow-up. Results: Out of the 24 children older than 10 y.o., twenty showed a premature complete physeal closure. We looked with interest at the 13 cases younger than 10 y.o. since the repercussions of iatrogenic physeal damage would obviously be bigger in this age group. Five out of the 13 showed premature closure and in the remnant eight an open growth plate was observed at follow-up. All patients with open and/or functioning physes after distraction had no local injuries in the growth plate prior to distraction (4 congenital short femora and 4 normal physes). On the contrary, four out of the five cases with prematurely closed physes, had a local physeal damage prior to distraction (3 bony bridges and one non-union), and the remnant was a congenitally short femur. Growth after distraction was difficult to assess in the congenitally short femora but it has been very satisfactory in the 4 cases of previously normal physes (2 benign tumours and 2 femoral shortenings due to hip disorders). In three cases of congenital short femur in pre-teenagers we were able to repeat distraction twice through the same physis, since it had remained open after the first distraction. Conclusions: Physeal premature closure often follows physeal distraction, but not always. The condition of the physis prior to lengthening is an important factor with influence on its viability after distraction

Distal radial fractures are common in children. Recent outcome studies have cast doubt on the success of treatment by closed reduction and application of plaster. The most important risk factor for poor outcome is translation of the fracture. If a distal radial fracture is displaced by more than half the diameter of the bone at the fracture site it should be classified as high risk. We performed percutaneous Kirschner-wire pinning on 157 such high-risk distal radial fractures in children under 16 years of age. The predicted early and late failure rate was reduced from 60% to 14% and only 1.5% of patients had significant limitation of forearm movement of more than 15 degrees in the final assessment at a mean of 31 months after operation. There were no cases of early physeal closure or deep infection

This study was performed to evaluate the results of transphyseal anterior cruciate ligament (ACL) reconstruction in children with open physes. Between 2001 and 2009, 31 knees in 29 patients with a mean age of 14.1 years (10-16) underwent transphyseal, arthroscopic ACL reconstruction using an autogenous four-strand hamstrings graft. The technique was identical to that used in the adult population in our unit, except that care was taken to ensure fixation did not cross the physes. The patients were followed up to the point of physeal closure at skeletal maturity. The mean length of follow up was 25 months. The primary outcome measure was graft survival. Functional outcome was measured using Lysolm scores, International Knee Documentation Committee (IKDC) scores and the Tegner activity scale. Post-operative clinical examination and radiological findings were also recorded. There were two cases of re-rupture following a further sports injury, one 12 months post-operative and one at six years. Both patients later had successful revision ACL reconstructive surgery. The re-rupture rate in this case series was 6%. Two patients underwent repair of a concomitant lateral meniscal tear at the time of surgery. The mean post-operative Lysolm score was 88 and the mean IKDC score was 88.1. The mean Tegner activity scale was 7.95. There was no evidence of growth disturbance radiologically or leg length inequality clinically. There was one case of deep infection which was successfully treated with two subsequent arthroscopic washouts. This study demonstrates that transphyseal arthroscopic ACL reconstruction using hamstrings graft and an ‘adult’ technique, in skeletally immature patients, provides good functional outcomes, has a low revision rate and is not associated with physeal growth arrest or disturbance

Out of a total of 112 children with displaced forearm shaft fracture treated with Percutaneous Kirschner (K) wire fixation in the past 9 years, 84 cases with fracture of both the radius and ulna were reviewed. 64 (76%) had fixation of both the radius and ulna, 10 (12%) the radius only and the other 10 (12%) the ulna only. In 60 (71%) patients were successful with one stage close reduction and pinning, while in the remaining 24 (29%) a semi- open reduction through a small incision was required. The K-wire was inserted through the radial styloid or the Lister tubercle for the radius, and through the tip of the olecranon for the ulna. All the patients reviewed were found to have good functional results with no non-union, deep infection or premature physeal closure at a mean follow-up of 48 months. Initial pre-operative shortening or translation of the fracture were associated with significantly higher chance of open reduction. We concluded that percutaneous K-wiring for forearm diaphyseal fracture in children is a convenient, effective and safe operation, with minimal complications

Aims

Triplane ankle fractures are complex injuries typically occurring in children aged between 12 and 15 years. Classic teaching that closure of the physis dictates the overall fracture pattern, based on studies in the 1960s, has not been challenged. The aim of this paper is to analyze whether these injuries correlate with the advancing closure of the physis with age.

Purpose of study: The majority of children with cerebral palsy suffer from fixed flexion contractures of their knees. Procedures commonly used to correct these deformities include hamstring releases, anterior femoral hemi-epiphyseodesis and femoral extension osteotomies. The latter procedure can cause neurovascular complications. Femoral stapling procedures are unpopular because of the risk of permanent physeal closure. Soft tissue procedures are usually only partially effective, with a high recurrence rate. We present our initial experience of correcting of knee flexion deformities using the 8-plate technique which uses guided growth in the distal femoral physis to achieve gradual correction of the knee flexion deformity. Method: The case notes of patients who underwent an anterior distal femoral hemi-epiphyseodesis using the 8-plate technique between April 2005 and August 2006 were analysed. A total of 18 limbs in 12 patients underwent this procedure. The pre- and post-operative flexion deformity was measured with a goniometer. Results: The mean age of the patients was 12.8 years (range 9–16) and the mean follow up was 8.5 months (range 3–15). The mean correction achieved was 16.15 degrees (range 5–40). Conclusions: This is a simple technique with a learning curve of 1 case and with few complications to date. All patients in our series have shown sustained gradual correction. We also present technical tips in the use of the 8-plate for anterior femoral hemi-epiphyseodesis

Purpose. To document the incidence and nature of complications associated with hemiepiphysiodesis using a screw and plate device (8-plate, Orthofix). Methods. We reviewed case notes and radiographs of 71 children (130 segments) with lower limb deformities treated with temporary hemiepiphyseal arrest using the 8-plate. 96% of deformities were in the coronal plane, 4% sagittal. 72% of coronal deformities demonstrated valgus malalignment. We defined three types of complications:. early (perioperative) complications eg infection and/or wound breakdown, bleeding, neurological impairment. implant related complications such as soft tissue irritation, plate breakage or migration,. complications involving the growth plate including rebound deformity, early physeal closure or iatrogenic deformity. Complications were related to variables of patient age, gender, diagnosis, location of deformity and associated surgery. Results. The average age at surgery was 10 years (range 3-16). There were 41 boys, 30 girls. 3/70 patients were treated for an idiopathic deformity: the remainder were affected by a wide range of pathologies (20% skeletal dysplasia, 20% metabolic bone disease). Full correction has occurred in 38% of patients. The remaining 45 children are all showing improvement in their deformity. 10 patients (14%) have had a complication: 3 patients had early complications (wound infection, wound breakdown and intra-operative hypotensive crisis) and 2 patients have had implant related complications (irritation and migration). In a further 5 patients there have been physis related problems: 1 over-correction, 1 recurrence and 3 cases in which the timing of the procedure or the ill-health of the physis did not allow correction to occur. Conclusion. The 8-plate is an effective device in the management of deformity secondary to pathological conditions. 10% of patients had complications: the majority were minor but care should be taken regarding the timing of the procedure related to the growth potential of the pathological physis

Introduction: Majority of children with cerebral palsy patients suffer from fixed flexion contractures of their knees. Procedures commonly used to correct knee flexion deformities include hamstring release, anterior femoral hemiepiphyseodesis and femoral extension osteotomies. The latter procedure can cause neurovascular complications. Femoral stapling procedures are not very popular because of a theoretical risk of permanent physeal closure. We present our initial experience in correction of knee flexion deformity by using the 8-plate technique. This uses guided growth in the distal femoral physis to achieve gradual correction of the knee flexion deformity. Materials and Methods: We analysed the case notes of patients who underwent an anterior distal femoral hemi-epiphyseodesis using the 8-plate techinique between April of 2005 and August 2006. A total of 18 limbs in 12 patients underwent this procedure. Preoperative and post operative flexion deformity was measured using a goniometer. All measurements were made by the senior surgeon. Results: The mean age of the patients was 12.8 years (range between 9–16). Mean follow up time for the patients after they had undergone the procedure was 8.5 months (range 3 – 15). The Mean correction achieved – 16.15 degrees (range 5 – 40). Conclusion: We conclude that this is a simple technique with few complications to date. The learning curve for this procedure is 1 case. All patients in our series have shown promising results, with sustained gradual correction to date. We also present technical tips in the 8-plate anterior femoral hemi-epiphyseodesis procedure

The purpose of this study is TO describe and illustrate a new method of reversible hemi-physeal tethering utilized for correcting various angular deformities of the extremities. Since hemi-physeal stapling was first introduced by Dr. Blount in 1950, this method has waxed and waned in popularity. Some associated problems include staple migration or breakage necessitating premature revision surgery. The author has devised a new construct comprising a two-hole plate and two screws to achieve gradual correction of deformities while averting the problems of hardware migration or breakage. In a pilot study, 25 children with 40 physeal deformities have been treated since 2001 utilizing the plate method. The children ranged in age from 19 months to 15 years and had a variety of underlying diagnoses. The plate is placed extraperiosteally and is removed upon attaining a neutral mechanical axis. No postoperative immobilization or limitation of weightbearing is required. In all cases short-term follow-up reveals improvement or resolution of deformity without need for osteotomy. Complications have included two early migration of short screws (< 16 mm) necessitating exchange for longer screws. There have been no premature or permanent physeal closures and no other significant peripoerative complications. Growth guidance employing a two hole plate and screws offers a secure and flexible means of redirecting the physis (es) in order to accomplish safe and gradual correction of angular deformities in children. Growth is reversible; the treatment is modular and may be repeated prn

Introduction: Majority of children with cerebral palsy patients suffer from fixed flexion contractures of their knees. Procedures commonly used to correct knee flexion deformities include hamstring release, anterior femoral hemiepiphyseodesis and femoral extension osteotomies. The latter procedure can cause neurovascular complications. Femoral stapling procedures are not very popular because of a theoretical risk of permanent physeal closure. We present our initial experience in correction of knee flexion deformity by using the 8-plate technique. This uses guided growth in the distal femoral physis to achieve gradual correction of the knee flexion deformity. Materials and Methods: We reviewed a consecutive series of 25 children with fixed flexion deformity of the knee who underwent anterior femoral hemiepiphysiodesis using a two-hole plate (8-plate) between April 2005 and April 2008. The pre-operative and postoperative knee flexion deformity (in degrees) and complication rates were also recorded. Paired t-Test was undertaken to assess the correction in the fixed flexion deformity post-operatively. Results: Total number of patients – 25, male:female = 19:6. Total number of limbs – 46. The mean age of the patients was 11.04 years (range between 4–16). Mean follow up time for the patients after they had undergone the procedure was 16.2 months (range 3 – 34). The Mean correction achieved − 21.52 degrees (range 5 – 40). Mean correction per month − 2.05 degrees. A paired ‘t’ test showed the correction was found to be highly statistically significant (p value < 0.001). Conclusion: We conclude that this is a simple technique with few complications to date. The learning curve for this procedure is 1 case. All patients in our series have shown promising results, with sustained gradual correction to date

Fractures of the hip in children have been associated with a very high rate of serious complications including avascular necrosis (up to 47%) and coxa vara (up to 32%). Over a period of 20 years, we have treated displaced fractures by early anatomical reduction, internal fixation and immobilisation in a spica cast to try to reduce these complications. We have reviewed 18 patients who had a displaced non-pathological fracture of the hip when under 16 years of age. Their mean age at the time of the injury was eight years (2 to 13). They returned for examination and radiography at a mean follow-up of eight years (2 to 17). Each patient had been treated by early (″24 hours) closed or open reduction with internal fixation and 16 had immobilisation in a spica cast. By Delbet’s classification, there was one type-I, eight type-II, eight type-III, and one type-IV fractures. There were no complications in 15 patients. Avascular necrosis occurred in one patient (type-III), nonunion in one (type-II, one of the two patients who did not have a cast) and premature physeal closure in one (type-I). There were no cases of infection or complications as a result of the cast. Our treatment of displaced hip fractures in children by early reduction, internal fixation, and immobilisation in a spica cast gave reduced rates of complications compared with that of large published series in the literature

Purpose of study: To evaluate the results of a consecutive series of displaced intracapsular paediatric femoral neck fractures treated by early closed reduction and Austin Moore Pin fixation. Method: Between 2001 and 2004, 14 paediatric patients with a mean age of 10 years suffering femoral neck fractures were identified. All traumatic epiphyseal, trans-cervical and basi-cervical femoral neck fractures were included. Pathological and intertrochanteric fractures were excluded. There were 11 male and 3 female patients. All patients were treated by reduction and internal fixation using Austin Moore pins. Patients were allowed to mobilize non-weight bearing with crutches for 3 months, followed by partial to full weight bearing. The mechanism of injury, associated injuries, time to reduction and time to union were reviewed. All patients were followed up till union. Mean follow up was 18 months. Patients were assessed clinically for pain, limp, use of walking aid, walking distance, stair climbing, cross leg sitting and squatting. Hip movements and limb length discrepancy were noted. Radiographs were analyzed to determine the adequacy of reduction, fracture healing and changes of avascular necrosis (AVN). Results: Mean injury-operation interval was 38.5 hours. Mean time to union was 16 weeks. All patients had excellent initial reduction which was maintained till healing. All patients’ fractures healed uneventfully. There were no complications in the form of non-union, AVN, premature physeal closure, angular deformity or implant back-out. Conclusions: Paediatric femoral neck fractures can be treated successfully with expeditious reduction and internal fixation. The risk of the devastating complication of AVN can be lessened with urgent surgery and near anatomical reduction