An 11-year-old obese boy complains of left hip and knee pain for 3 weeks. On examination, as he flexes the left hip, obligatory external rotation occurs. X-ray (frog-leg view) shows posteromedial displacement of the left femoral epiphysis. This is SCFE. The Southwick angle is 45°. How is this graded and what treatment is indicated?

• A Mild SCFE — Southwick angle <30°; treat with physeal compression screw
• B Moderate SCFE — Southwick angle 30–60°; treat with single cannulated screw in situ fixation ✓
• C Severe SCFE — Southwick angle >60°; treat with corrective subtrochanteric osteotomy
• D Moderate SCFE — reduction under anaesthesia followed by pinning is mandatory

Explanation

SCFE is graded by the Southwick slip angle: mild <30°, moderate 30–60°, severe >60°. A Southwick angle of 45° is moderate SCFE. The standard treatment for stable moderate SCFE is in situ single-screw fixation (cannulated cancellous screw placed centrally in the femoral neck, perpendicular to the physis) — this arrests further slippage and allows physeal fusion. Reduction attempts increase avascular necrosis risk and are avoided in stable SCFE. Osteotomy is reserved for severe slips or correcting residual deformity after physeal closure.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.