SCFE: Which description best matches slipped capital femoral epiphysis?

SCFE: Which description best matches slipped capital femoral epiphysis?

• A. A 7-year-old Caucasian athletic female with acute hip pain after a fall
• B. A 16-year-old Hispanic male with sudden groin pain after sprinting
• C. 13-year-old African-American athletic obese male with insidious hip/thigh/knee pain and a limp; external rotation of the affected leg
• D. 12-year-old Asian male with knee swelling and fever

Answer: (C)

Slipped capital femoral epiphysis shows up in mid‑adolescence with an insidious onset of hip or referred knee pain and a limp, most often in an overweight patient going through a rapid growth period. A telling sign is the leg held in external rotation, with reduced internal rotation of the hip on exam. The described patient fits this pattern precisely: a pubertal, obese, athletic teenager with gradual hip/thigh/knee pain and a limp, plus the leg externally rotated. This external rotation occurs because the femoral head has slipped posteriorly and inferiorly through the growth plate, altering hip mechanics and pain location. Urgent orthopedic evaluation is needed, with pelvic radiographs (AP and frog‑leg lateral) to confirm the slip. Treatment is in‑situ surgical fixation to prevent further slip and reduce risk of avascular necrosis. The other scenarios don’t fit as well: very young age after a fall suggests a traumatic injury; sudden pain after sprinting can occur but obesity and insidious onset are less typical for SCFE; knee swelling with fever points to infection rather than a SCFE.

Slipped capital femoral epiphysis shows up in mid‑adolescence with an insidious onset of hip or referred knee pain and a limp, most often in an overweight patient going through a rapid growth period. A telling sign is the leg held in external rotation, with reduced internal rotation of the hip on exam. The described patient fits this pattern precisely: a pubertal, obese, athletic teenager with gradual hip/thigh/knee pain and a limp, plus the leg externally rotated. This external rotation occurs because the femoral head has slipped posteriorly and inferiorly through the growth plate, altering hip mechanics and pain location.

Urgent orthopedic evaluation is needed, with pelvic radiographs (AP and frog‑leg lateral) to confirm the slip. Treatment is in‑situ surgical fixation to prevent further slip and reduce risk of avascular necrosis. The other scenarios don’t fit as well: very young age after a fall suggests a traumatic injury; sudden pain after sprinting can occur but obesity and insidious onset are less typical for SCFE; knee swelling with fever points to infection rather than a SCFE.