A 12-year-old obese boy has a painful limp and limited internal rotation of the right hip. X-ray shows posterior and medial displacement of the right femoral head relative to the femoral neck on the frog-leg lateral view. What is the diagnosis, and what is the immediate management?

• A Perthes disease; conservative management with abduction splinting
• B Slipped capital femoral epiphysis (SCFE); immediate non-weight bearing and urgent in situ fixation with a single cannulated screw ✓
• C Developmental dysplasia of the hip; femoral osteotomy
• D Transient synovitis; rest and NSAIDs for 2 weeks

Explanation

SCFE is most common in overweight adolescent males aged 10–14 years. The epiphysis displaces posteromedially relative to the metaphysis (the femoral neck moves anterolaterally). The frog-leg lateral view is more sensitive than the AP view. Immediate non-weight bearing prevents further slip, and in situ fixation with a single cannulated screw through the physis is the standard treatment regardless of slip severity. Reduction attempts increase the risk of avascular necrosis.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.