A child with obesity presents with a limp and dull knee pain. Exam reveals tenderness at the anterior hip and limited internal rotation. Plain radiographs show subluxation of the right femoral head. What is the next step in management?

• A. Observation and physical therapy
• B. Traction followed by casting
• C. Operative stabilization with surgical pinning
• D. Antibiotics and immobilization

Answer: (C)

Slipped capital femoral epiphysis in an obese adolescent is an orthopedic emergency. The hallmark is hip pain with limited internal rotation, and pain referred to the knee. Radiographs showing displacement of the femoral head across the growth plate confirm the diagnosis. The priority is immediate surgical stabilization of the slip with in-situ percutaneous pinning (screw fixation). This fixes the epiphysis in its current position, prevents further slipping, and reduces the risk of complications such as avascular necrosis and chondrolysis.

Delaying for observation, or attempting traction and casting, does not address the unstable mechanics of the slip and can worsen outcomes. Antibiotics with immobilization are reserved for septic processes, not a mechanical physeal slip.