A 14-year-old boy who is overweight develops a unilateral limp with hip and knee pain; examination shows external rotation of the hip and pain with internal rotation. What is the most important initial step?

A 14-year-old boy who is overweight develops a unilateral limp with hip and knee pain; examination shows external rotation of the hip and pain with internal rotation. What is the most important initial step?

• A. Crutches and wheelchair to prevent weight-bearing
• B. See orthopedic specialist as soon as possible
• C. Weight loss information to address obesity
• D. Referral to physical therapy for range-of-motion improvement

Answer: (A)

This picture fits slipped capital femoral epiphysis (SCFE) in an overweight adolescent who has a unilateral limp and hip pain, with the exam finding of external rotation and pain on internal rotation. The most important initial step is to keep weight off the affected leg—non-weight-bearing with crutches or a wheelchair. Why this is the priority: SCFE is a condition where the femoral head slips at the growth plate, and applying weight increases shear forces that can worsen the slip and raise the risk of serious complications like avascular necrosis. Immobilizing the joint and preventing further weight-bearing helps limit progression while you arrange urgent orthopedic evaluation and imaging to confirm the diagnosis and plan definitive treatment, usually surgical stabilization. Weight loss information or physical therapy don’t address the immediate risk of further slip, and while seeing an orthopedic specialist promptly is essential, the very first action you take in this scenario is to prevent weight-bearing.

This picture fits slipped capital femoral epiphysis (SCFE) in an overweight adolescent who has a unilateral limp and hip pain, with the exam finding of external rotation and pain on internal rotation. The most important initial step is to keep weight off the affected leg—non-weight-bearing with crutches or a wheelchair. Why this is the priority: SCFE is a condition where the femoral head slips at the growth plate, and applying weight increases shear forces that can worsen the slip and raise the risk of serious complications like avascular necrosis. Immobilizing the joint and preventing further weight-bearing helps limit progression while you arrange urgent orthopedic evaluation and imaging to confirm the diagnosis and plan definitive treatment, usually surgical stabilization.

Weight loss information or physical therapy don’t address the immediate risk of further slip, and while seeing an orthopedic specialist promptly is essential, the very first action you take in this scenario is to prevent weight-bearing.