A 12-year-old obese boy presents with right hip pain referred to the knee, with limited internal rotation on examination. Plain radiograph shows epiphyseal displacement with a positive Klein's line sign. Emergency surgical management consists of:
- A Hip spica casting and bed rest for 6 weeks
- B Closed reduction under general anaesthesia and capsular distension
- C In situ fixation with a single cannulated screw through the physis ✓
- D Open reduction and subtrochanteric osteotomy immediately
Explanation
Slipped capital femoral epiphysis (SCFE) is confirmed by Klein's line not intersecting the femoral epiphysis on the AP view. For stable and unstable SCFE, the standard of care is urgent in situ percutaneous cannulated screw fixation (typically a single screw placed centrally in the epiphysis crossing the physis). The screw stabilises the epiphysis and prevents further slippage, and physeal fusion occurs. Aggressive attempted reduction (B) is contraindicated in most SCFE because it risks avascular necrosis of the femoral head — in situ fixation preserves the already compromised blood supply. Corrective osteotomy (D) is reserved for severe deformity causing functional impairment after physeal closure.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.