Case scenario

A 13 year old boy visited the general practitioner because of a six week history of intermittent limp and pain in the left lower thigh and knee, which was exacerbated by playing sports. On examination he was overweight, but he had no abnormality in the knee. “Knee strain” was diagnosed, and he was advised to take ibuprofen and abstain from sports. Four weeks later he returned with worsening more persistent pain, now in the thigh as well as the knee. Careful examination of the hip elicited a degree of restriction of flexion and rotation, both internal and external, with 2 cm shortening of the affected leg. Radiography of the left hip showed a slipped capital femoral epiphysis.