الفهرس 
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Abstract
Aim of the study : The aim of the study is to evaluate the incidence and risk factors of avascular necrosis after open reduction of developmental dislocation of the hip in children after walking age. Materials and methods: This study included 200 cases with age range from 1 years to 7 years and the average age is 3.5 years at the time of last follow up. girls predominance was evident in the form of 165 girls. right side predominance was reported in 105 cases (52.5%) and the left side in 95 cases (47.5%). the mean time of intervention was 2.26 years ± 0.97 years with age range from 1 years to 5 years. In this study, 26 cases managed only by open reduction and capsulorrhaphy (13%), 174 cases had pelvic osteotomies (72.5%) either Salter or Dega osteotomy of whom 104 had femoral shortening and derotational osteotomy (59.77%). In this study, 170 cases had post-operative hip abduction <60° (85%) and 30 cases had post-operative hip abduction ≥60°. Results: In this study, no AVN was reported in 159 cases (79.5%) while AVN was evident in 41 cases (20.5%). In this study, overall final clinical results were excellent in 67 patients (33.5%), good in 118 (59%), fair in 12 (6%) and poor in 3 patients (1.5%), satisfactory (excellent and good) in 185 patients (92.5%) and unsatisfactory (fair and poor) in 15 patients (7.5%). In this study, femoral head wasn’t affected in 142 cases (71.0%) while 44 cases (22%) had delayed appearance of ossific nucleus. 14 cases (7%) had flattened femoral head. In this study, Comparison of incidence of AVN according to Age groups showed statistical significant difference (P<0.05) between patients with and without AVN. Incidence of AVN increased after 2.5 years by 35 cases (85%). In this study, Comparison of gender and side between patients with and without AVN showed statistical insignificant difference (P>0.05). In this study, preoperative femoral head state showed statistical significant difference (P<0.05) between patients with and without AVN. No AVN was reported in 159 cases of whom 120 cases (75.5%) showed femoral head wasn’t affected while 30 cases (18.8%) presented with delayed appearance of ossific nucleus, and 9 cases (5.7%) presented with flattening of femoral head. AVN was reported in 41 cases in the form of 22 cases (53.7%) with the femoral head not affected, 14 cases (34.1%) presented with delayed appearance of ossific nucleus and 5 cases (12.2%) presented with flattening of femoral head. In this study time of intervention between patients with and without AVN showed statistical significant difference (P<0.05) with mean time of AVN cases was 3.2years ± 1.15years while type of intervention (pelvic osteotomy and or femoral osteotomy) showed statistical insignificant difference (P>0.05) between patients with and without AVN. In this study, post-operative immobilization in hip spica between patients with and without AVN showed statistically significant difference (P<0.05).150 cases with post-operative hip abduction <60° showed no AVN while other 20 cases showed AVN. 9 cases with post-operative hip abduction ≥60° showed no AVN while the other 21 cases showed AVN. Conclusion : This study was done on 200 cases with age of the children ranged from 1 year to 7 years with mean age at the time of surgery 2.26 ± 1.6 years with girls predominance by 82.5% showed the incidence of AVN was 20.5%. Incidence of AVN increase in cases with delayed time of intervention with delay appearance of ossific nucleus and postoperative hip abduction ≥60.