Slipped Capital femoral Epiphysis


SYMPTOMS/EXAM

DIAGNOSIS

TREATMENT

  1. Unstable SCFE:
  2. Stable SCFE:
  3. Late deformity:








 

ITE 2013, Q#52. A 13-year-old African-American male is brought to your office by his mother for a limp that she has noticed for about 1 week. The patient admits to vague right-sided hip and knee pain present only with activity. He says the pain has never awakened him from sleep and is never present at rest. Neither the mother nor the patient has noticed any systemic symptoms such as fever, night sweats, weight loss, or appetite changes. There is no recent history of trauma.
On examination the patient’s weight is in the 90th percentile and his height is in the 50th percentile. He has an antalgic gait. Examination of the left hip is normal. Examination of the right hip is significant for decreased internal rotation. The right hip externally rotates involuntarily with passive flexion. There is no external deformity and no skin changes are noted. He has a negative FABER test. Palpation of the bursa and bone does not elicit pain. Examination of both knees is normal. Plain radiographs confirm your clinical impression.

Which one of the following is the most appropriate next step in the management of this patient?

A) Reassurance with close follow-up
B) Physical therapy
C) Injection of the sacroiliac joint
D) Hospital admission for intravenous antibiotics
E) Surgery

ANSWER: E