Hip fractures are rare in children, and most of these fractures are caused by high-energy trauma from motor vehicle accidents or falls from height. Hip fractures in children have a high incidence of complications, including hip inversion, fracture non-union, premature epiphyseal closure, and the most serious consequence, ischemic necrosis (ON) of the femoral head. The incidence of ischemic necrosis of the femoral head after hip fracture in children has been reported in the literature as 0% to 92%. Many studies have examined the risk factors for ON and found that Delbet staging is a good predictor of ischemic necrosis of the femoral head after hip fracture in children, and although Delbet type 1 or transapophysis hip fractures are uncommon, they have a high incidence of ON, even up to 100%. However, a meta-analysis by Moon et al. showed that the incidence of ischemic necrosis of the femoral head was only 38% for Delbet type 1 hip fractures and 28%, 18% and 5% for Delbet type 2, 3 and 4 hip fractures, respectively. Many studies have also found that age, degree of fracture displacement, treatment modality (surgical or conservative), time between injury and fracture reduction and fixation, and intra-articular capsular decompression can affect ON after hip fracture in children, but there are few factors that are truly statistically different. Patrick et al. hypothesized that repositioning and fixation within 12 hours of hip fracture in children would reduce the chance of ischemic necrosis of the femoral head, with Delbet’s staging, degree of fracture displacement, quality of repositioning, and intracapsular decompression as risk factors. Therefore, Dr. Patrick et al. conducted a study, which was recently published in JOT. A total of 255 hip fractures between 1983 and 2009 at this pediatric level II trauma hospital were studied, and 43 patients (44 fractures) were included after excluding metabolic disease, subrotor fractures, pathologic fractures, slipped femoral epiphysis, and patients with less than 1 year of follow-up. A standard method of internal fixation with repositioning was used intraoperatively. Data were collected on age, Delbet’s staging, degree of fracture displacement, time from injury to fracture reduction and fixation, method of reduction (closed or incisional), quality of reduction, and whether intracapsular decompression was performed. Risk factors were then analyzed between the ON and non-ON groups using the Fish exact test, and then compared between the two groups. Ischemic necrosis of the femoral head occurred in 9 of 44 (20%) pediatric hip fractures, with age ≥11 years being the only independent risk factor for ON. Therefore, early fracture reduction and fixation (within 12 hours) did not reduce the incidence of ischemic necrosis of the femoral head after hip fracture in children. Severe Delbet 1B hip fracture with split femoral head fracture in a 12-year-old patient: A preoperatively; B 10.5 years later The above results indicate that the incidence of ON after hip fracture in children was 20%, and none of the children aged less than 11 years had ON after hip fracture, and early reduction did not reduce the incidence of ON.