An 11-year-old obese boy presents with right hip pain and limp for 2 weeks. On examination, passive internal rotation is restricted and pain is referred to the medial knee. Plain radiograph shows Klein's line not intersecting the femoral head epiphysis and a 'ice cream falling off the cone' appearance. The FIRST step in management is:
- A Urgent surgical in situ pinning with a single cannulated screw ✓
- B Non-weight-bearing, traction, and gradual range of motion exercises
- C Osteotomy to restore the normal femoral head-neck relationship
- D Hip spica cast for 6–8 weeks
Explanation
Slipped capital femoral epiphysis (SCFE) is a Salter-Harris Type I fracture through the proximal femoral physis, with the femoral head epiphysis slipping posteriorly and inferiorly. Klein's line (tangent to the superior femoral neck) normally intersects the lateral fifth of the epiphysis; if it does not (Trethowan's sign), SCFE is confirmed. The immediate treatment, even before weight-bearing status changes, is surgical in situ pinning with a single cannulated screw placed in the center of the epiphysis under fluoroscopic guidance. The risk of avascular necrosis is greatly increased by attempts at reduction; in situ pinning is preferred. Unstable SCFEs require urgent surgery.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.