A Race against Time: Managing Acute Unstable Slipped Capital Femoral Epiphysis in a 15-year old with Normal Body Mass Index using the Modified Dunn's Procedure - A Case Report.

Abstract

Introduction: Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents, characterized by the displacement of the femoral head from the femoral neck along the physeal plate. Diagnosis relies on clinical evaluation and radiographic imaging, with classification based on duration, stability, and severity. The standard treatment is in situ pinning using a single cannulated screw to stabilize the epiphysis. However, the modified Dunn procedure (MDP) has emerged as an alternative, particularly for unstable slips, aiming to reduce osteonecrosis risk. SCFE is associated with significant complications, including osteonecrosis, chondrolysis, slip progression, and femoro-acetabular impingement. Long-term management focuses on preserving hip function and delaying the need for hip arthroplasty.

Case report: A 15-year-old boy with normal body mass index (BMI) of 18.6 kg/m2 had trivial fall while playing and had difficulty in walking. Five days post injury, he was not able to weight bear with increasing progression of pain. Based on radiographs, SCFE was suspected and computed tomography scan was done to confirm the slip. He underwent MDP and started on post-operative rehabilitation protocol.

Conclusion: This review shows the effectively managed acute presentation of SCFE in normal BMI children. Sudden trauma does not rule out SCFE and a differential diagnosis to be always considered along with fractures.