An obese 13-year-old boy presents with 3 weeks of left thigh and knee pain and a limp. Examination shows the left hip held in external rotation with obligatory external rotation of the thigh on passive flexion. Radiographs show posterior and inferior displacement of the femoral head relative to the neck. What is the most likely diagnosis?

• A Legg-Calve-Perthes disease
• B Slipped capital femoral epiphysis ✓
• C Osgood-Schlatter disease
• D Septic arthritis of the hip

Explanation

SCFE is displacement of the capital femoral epiphysis posteroinferiorly through the growth plate, classically in overweight adolescents near puberty. Knee or thigh referred pain with a limp is common and delays diagnosis, so every adolescent with knee pain needs hip examination and radiographs. Perthes affects younger children with epiphyseal fragmentation rather than displacement of the whole epiphysis off the neck.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.