A 14-year-old obese boy presents with a 2-week history of left hip pain and limp. He can bear weight with discomfort. X-ray of the pelvis shows posterior and inferior displacement of the proximal femoral epiphysis relative to the metaphysis. Which of the following is the most appropriate management?
- A In situ percutaneous cannulated screw fixation without reduction ✓
- B Urgent closed reduction under anesthesia followed by spica casting
- C Open reduction and capsulorrhaphy
- D Skeletal traction for 6 weeks followed by hip spica cast
Correct answer: A. In situ percutaneous cannulated screw fixation without reduction
Explanation
In stable slipped capital femoral epiphysis, the treatment of choice is in situ percutaneous screw fixation across the physis without attempted reduction. Forceful manipulation or aggressive closed reduction risks tearing the retinacular vessels, causing avascular necrosis of the femoral head. B single cannulated screw is placed centrally to stabilize the slip and promote physeal fusion, preventing further displacement while avoiding this devastating complication.
Reference: Campbell's Operative Orthopaedics, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.