Which feature is most characteristic and would prompt urgent referral for slipped capital femoral epiphysis?

Which feature is most characteristic and would prompt urgent referral for slipped capital femoral epiphysis?

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

Answer: (C)

The pattern being tested is recognizing the classic presentation of slipped capital femoral epiphysis and why it needs urgent referral. In SCFE, an adolescent with a limp and hip or knee pain often shows limited internal rotation of the hip, and when the hip is flexed, the leg tends to rotate externally. That combination—limp with hip/knee pain plus restricted internal rotation that becomes evident with hip flexion and an obvious external rotation—is highly characteristic and signals the need for urgent referral to prevent progression and potential complications like avascular necrosis.

The other scenarios don’t fit SCFE as well: preserving internal rotation or improving hip motion with a limp isn’t typical, and isolated foot pain isn’t the pattern seen in SCFE.