Which adolescent hip symptom would prompt urgent referral for suspected slipped capital femoral epiphysis?

Which adolescent hip symptom would prompt urgent referral for suspected slipped capital femoral epiphysis?

• A. Limp with knee pain and preserved internal rotation.
• B. Limp with normal internal rotation.
• C. Pain in the ankle only.
• D. Acute or gradual onset limp with hip/knee pain and limited internal rotation; external rotation with flexion.

Answer: (D)

In adolescents, slipping of the capital femoral epiphysis presents most reliably with a limp and hip or knee pain, plus a clear change in how the hip moves—the hip loses internal rotation, especially when bent, and the leg often lies in external rotation when the hip is flexed. This combination is a red flag because SCFE is an orthopedic emergency: delaying treatment can allow the slip to progress and increase the risk of complications like avascular necrosis. The option describing an acute or gradual limp with hip or knee pain and limited internal rotation, with external rotation when the hip is flexed, matches that pattern and is the best clue for urgent referral. The other scenarios lack the key sign of reduced internal rotation or involve pain not typical of hip pathology, so they are less concerning for SCFE.