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Slipped upper femoral epiphysis — MSRA MCQ

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HardHip and GroinSlipped upper femoral epiphysisMSRA

A 13-year-old boy presents with 4 weeks of intermittent left knee and distal thigh pain and a limp. Since stepping off a low kerb this morning, he has developed severe left groin pain and is now unable to weight-bear. He has obesity (BMI 31 kg/m²) and is otherwise well. His temperature is 36.8°C. The left knee has no effusion, tenderness or restriction of movement. The left leg rests externally rotated. Hip flexion is painful and internal rotation is markedly restricted. There is no erythema, swelling or focal bony tenderness. What is the most appropriate immediate management in general practice?

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

Reveal the answer and explanation

Correct answer: B — Keep him non-weight-bearing and arrange immediate same-day emergency orthopaedic assessment for suspected slipped upper femoral epiphysis

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

This is a probable acute-on-chronic slipped upper femoral epiphysis (SUFE): an adolescent with obesity has referred knee/thigh pain, a normal knee examination, restricted hip internal rotation and an externally rotated resting leg. Sudden deterioration to inability to weight-bear indicates an acute slip or acute worsening, for which preventing further displacement is the immediate priority. He should not be allowed to weight-bear and requires same-day emergency orthopaedic assessment. A is unsafe because continued weight-bearing may worsen displacement; imaging will be arranged in the emergency orthopaedic pathway. C underestimates the urgency of an acute presentation. D would be reasonable only for a convincing transient synovitis presentation, typically in a younger child who is systemically well with preserved hip movement and improving symptoms; this presentation has specific features of SUFE. E is attractive because an acutely painful non-weight-bearing hip requires consideration of septic arthritis, but he is afebrile, well and has a characteristic mechanical pattern. Blood tests or ultrasound must not delay urgent referral when acute SUFE is suspected.

Reference: NHS Tayside RefGuide: Slipped Upper Femoral Epiphysis (Reviewed 3 July 2024; next review 3 July 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