Complete, unstable proximal femoral fractures carry a significant risk of avascular necrosis (AVN) of the femoral head. AVN can result from entrapping or rupturing the retinacular vessels during a closed reduction maneuver. Decompression of hemarthrosis may reduce the risk of AVN. The focus will, therefore, be on open procedures, which aim to reduce this risk. Detailed knowledge of the vascular supply of the femoral head is a prerequisite for safe treatment and the management of femoral neck fractures in children ideally requires experience in hip surgery.