A 13-year-old obese boy complains of left groin pain radiating to the knee for 3 months; left hip X-ray (AP and frog-leg lateral) shows a posterior-inferior displacement of the left femoral epiphysis relative to the neck (SCFE). The right hip is currently asymptomatic. The most appropriate management approach is:
- A Bilateral hip pinning regardless of right hip appearance
- B Open reduction of the left slip by Dunn procedure is the first-line
- C In-situ pinning of the left slip (single screw central placement); right hip prophylactic pinning is indicated if contralateral slip risk factors include age <10, endocrinopathy, or bilateral presentation ✓
- D Conservative management with weight bearing restriction alone
Explanation
In-situ single-screw percutaneous pinning is the standard treatment for stable SCFE (patient can bear weight) regardless of severity — the screw is placed centrally perpendicular to the physis and parallel to the neck axis without attempting reduction (reduction attempts increase AVN risk). Prophylactic contralateral pinning is recommended when the risk of contralateral slip is high: patients under age 10 at onset, those with endocrinopathies (hypothyroidism, growth hormone deficiency, renal osteodystrophy), or when radiographic pre-slip changes are seen. In a typical 13-year-old boy, contralateral slip risk without these features is lower; many surgeons still discuss it but guidelines support selective rather than routine bilateral pinning. Dunn osteotomy is reserved for severe symptomatic slip (grade 3, >60° slip angle) with detailed surgical planning.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.