A 13-year-old obese male with hypothyroidism presents with a 3-week history of left hip pain and a limp. Examination shows restricted internal rotation and obligatory external rotation on hip flexion. X-ray shows a posterior and inferior displacement of the left femoral epiphysis. What is the FIRST priority in management?
- A Non-weight bearing and urgent in situ pinning with a single cannulated screw ✓
- B Immediate open reduction to restore normal anatomy before fixation
- C Hip spica cast for 6–8 weeks followed by elective pinning
- D Corrective osteotomy at the level of the slipped epiphysis
Explanation
Slipped capital femoral epiphysis (SCFE) management priority is to prevent further slip and AVN. Current standard of care is in situ pinning with a single cannulated screw as soon as possible — the screw crosses the physis and holds the epiphysis without attempting to reduce the slip (reduction attempts dramatically increase AVN risk). Non-weight bearing is maintained until surgery. Open reduction is contraindicated for stable SCFE. Hip spica alone is historical and inadequate. Corrective osteotomies (e.g., Southwick) are performed electively for residual deformity after physeal closure.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.