SCFE: What is the initial management?

• A. Non-weight bearing with crutches
• B. Immediate open reduction with internal fixation
• C. Physical therapy and range-of-motion exercises
• D. Weight-bearing as tolerated

Answer: (A)

SCFE is a mechanical instability where the femoral head slips through the growth plate in adolescents. The priority is to prevent further displacement, so the patient should be kept non-weight bearing with crutches, with analgesia and urgent orthopedic evaluation for stabilization (usually in situ pinning). Weight-bearing the slip can worsen displacement and increase the risk of complications such as avascular necrosis, so it is not appropriate as an initial step. Physical therapy and ROM exercises don’t address the instability, and immediate surgical reduction is definitive but not the first action—the slip must be stabilized after minimizing further movement.