A 12-year-old obese boy presents with right groin pain and a limp. His right hip is externally rotated at rest, and internal rotation is painful and restricted. X-ray shows widening of the physis with posterior-inferior displacement of the femoral head on the frog-leg lateral view. The FIRST step in management is:

• A Closed reduction under anaesthesia and hip spica casting
• B Open reduction and fixation to correct the slip angle
• C Observation for 6 months to assess natural history
• D Non-weight bearing and urgent in-situ fixation with a single cannulated screw ✓

Explanation

Slipped capital femoral epiphysis (SCFE) is an orthopedic emergency. Once diagnosed, the patient must be made non-weight bearing immediately to prevent further slippage. In-situ fixation with a single cannulated screw (perpendicular to the physis) is the gold standard treatment for both stable and unstable SCFE, achieving physeal arrest to prevent progression without manipulative reduction (which risks avascular necrosis). Forceful closed reduction is contraindicated as it dramatically increases the risk of AVN (up to 50%). The contralateral hip should also be assessed as bilateral SCFE occurs in 25-40%.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.