A 13-year-old obese boy presents with left hip pain radiating to the knee, a limp, and limited internal rotation with obligate external rotation on hip flexion. X-ray shows posterior inferior displacement of the femoral epiphysis. This is SCFE. The most important immediate management is:

• A Non-weight-bearing on crutches and urgent MRI of hip
• B Closed reduction under general anaesthesia followed by spica cast
• C Urgent in-situ pinning with a single cannulated screw without attempted reduction ✓
• D Open reduction via surgical hip dislocation (Ganz approach)

Explanation

SCFE treatment is surgical stabilization to prevent further slippage and avascular necrosis. In-situ pinning with a single cannulated screw (without reduction) is the standard of care for stable SCFE (all grades); reduction is avoided because it dramatically increases the risk of avascular necrosis (from 0–5% to >30%). Urgent in-situ fixation prevents progression. In unstable SCFE (acute severe slip with inability to weight-bear), gentle positioning but no forceful reduction is the guideline; some centers use modified Dunn osteotomy (Ganz approach) but this is a specialist procedure. Contralateral prophylactic pinning is controversial but recommended in high-risk groups (young, obese, endocrine disorders).

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.