An 11-year-old boy presented with left hip and knee pain for over a week causing him to limp. On examination, he had some pain with internal rotation of the left hip. The most important part of management is not missing the diagnosis of slipped capital femoral epiphysis (SCFE) which can lead to avascular necrosis if missed. SCFE can present as referred knee pain, so hip evaluation is needed. Orthopedic consultation for possible operative repair is recommended.

2.  11 year old boy is brought  PE
in by his mother for left  Afebrile. VSS.
hip and knee pain. The  Gen: Well appearing.
boy says the pain has Non toxic.
been going on for over a
 Extrem: Fairly benign
week and its causing him
exam. Has some pain
to limp. They deny
with internal rotation of
fevers or trauma.
left hip

4.  The most important part of ED management is not
missing the diagnosis. Missed SCFE can lead to
avascular necrosis
 Note that SCFE can present as knee pain that is
referred from the hip so complaints of knee pain
should prompt evaluations of the hip
 Orthopedic consultation should be considered
emergent. SCFE is ultimately treated with ORIF.

6.  Loder, R. “Slipped Capital Femoral Epiphysis”.
American Family Physician. 1999.
 Kevin, Walter et al. “Slipped Capital Femoral
Epiphysis”. Emedicine.com. 12/2009.
 Tininalli, J et al. “Emergency Medicine: A
Comprehensive Study Guide”. 6th ed. 2003
 Wheeless, C. “Slipped Capital Femoral Epiphysis”.
Wheelessonline.com. 5/2011