A 10-year-old boy presents with a slipped capital femoral epiphysis secondary to hypothyroidism. The left hip is pinned. His right hip has an open proximal femoral physis and no symptoms. Which feature most strongly justifies prophylactic pinning of the asymptomatic right hip?

• A Male sex
• B Age below 12 years with an underlying endocrine disorder ✓
• C Obesity alone
• D Radiological evidence of mild physeal widening on the right

Explanation

Prophylactic fixation of the contralateral hip is recommended in patients with an underlying endocrine or metabolic disorder such as hypothyroidism, growth hormone excess, or renal osteodystrophy, and in young patients with a large open physis, generally under 10 to 12 years, because the risk of a second slip is very high in these groups. Isolated obesity raises overall slip risk but does not by itself mandate prophylactic pinning.

Reference: Tachdjian's Pediatric Orthopaedics, 5th ed.

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