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Unstable slipped upper femoral epiphysis — MSRA MCQ

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HardHip and GroinUnstable slipped upper femoral epiphysisMSRA

A 13-year-old boy is seen urgently in general practice with severe left knee pain after turning quickly during football yesterday. For 5 weeks beforehand, he had intermittently limped after activity and described vague pain in the left groin and anterior thigh. He has a BMI above the 99th centile. He is afebrile and systemically well. His left knee has no effusion, focal tenderness or restriction of movement. He cannot take any weight through the left leg, even with crutches. The left hip rests in external rotation; passive internal rotation is markedly restricted and reproduces his pain. What is the most appropriate immediate management plan?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Arrange immediate transfer to paediatric emergency care, keep him non-weight-bearing, and obtain bilateral anteroposterior and cross-table lateral hip radiographs

Explanation lettering: D = shown as A · C = shown as B · A = shown as C · B = shown as D

This is an acute-on-chronic slipped upper femoral epiphysis (SUFE), clinically unstable because he cannot bear weight. His preceding groin/thigh symptoms, obesity, referred knee pain with a normal knee examination, externally rotated resting posture and loss of hip internal rotation are strongly discriminatory. In a child with knee pain, the hip must be examined because SUFE may present with knee pain alone. Acute SUFE requires urgent operative stabilisation, so he needs immediate paediatric emergency/orthopaedic assessment and must not weight-bear. ([rightdecisions.scot.nhs.uk](https://www.rightdecisions.scot.nhs.uk/nhs-tayside-refguide/surgery-and-orthopaedics/orthopaedic-and-trauma-surgery/paediatric-orthopaedics/childrens-hip-problems/slipped-upper-femoral-epiphysis/?UNLID=69922338202631204115&utm_source=openai)) Cross-table lateral rather than frog-leg lateral imaging is appropriate in unstable SUFE; frog-leg views are used for stable slips, whereas unstable slips require anteroposterior and cross-table lateral radiographs. ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/28671425/?utm_source=openai)) B is therefore unsafe despite correctly recognising SUFE and arranging urgent review. C wrongly localises the pathology to the knee. D delays definitive emergency assessment and permits weight-bearing. E is inappropriate because transient synovitis is less likely in an adolescent with marked hip restriction and inability to weight-bear.

Reference: Slipped Upper Femoral Epiphysis | Right Decisions (Current page; next review 03/07/2027) — https://www.rightdecisions.scot.nhs.uk/nhs-tayside-refguide/surgery-and-orthopaedics/orthopaedic-and-trauma-surgery/paediatric-orthopaedics/childrens-hip-problems/slipped-upper-femoral-epiphysis/?UNLID=69922338202631204115 Slipped Capital Femoral Epiphysis: Diagnosis and Management (2017) — https://pubmed.ncbi.nlm.nih.gov/28671425/