Bilateral Slipped Capital Femoral Epiphysis in an Obese Patient: A Case Report and Review of Literature

Abstract

Slipped capital femoral epiphysis (SCFE), the predominant hip disorder affecting pre-adolescent and adolescent populations, exhibits a significant clinical association with obesity. We present a case of a 10-year-old obese boy who initially presented with unilateral thigh pain following minor trauma, with the initial radiographs misinterpreted as normal and was discharged. Three weeks later, he developed bilateral hip pain and antalgic gait. Subsequent imaging studies confirmed SCFE (Southwick grade I), confirmed by a positive Klein’s line and physeal widening. The patient underwent successful bilateral percutaneous in-situ fixation using cannulated screws. Postoperatively, a strict non-weight-bearing (NWB) protocol was implemented for 6–8 weeks, followed by progressive partial weight-bearing (PWB), resulting in normal hip range of motion and resolution of pain by the tenth week. This case highlights the diagnostic challenges associated with early and atypical presentations of SCFE, particularly among obese populations, in whom subtle radiographic findings may be overlooked. Standard management involves in-situ screw fixation to stabilize the physis and prevent further slippage, aiming to minimize long-term complications such as avascular necrosis and femoroacetabular impingement. Prophylactic contralateral hip fixation remains a topic of clinical debate but still considered in high-risk patients. Postoperative weight-bearing protocols remain variable, with a trend toward individualized, staged rehabilitation based on slip severity and stability. This case underscores the importance of early recognition and thorough radiographic assessment, including both anteroposterior and lateral imaging in pediatric patients presenting with hip, thigh, or knee pain, particularly those with risk factors such as obesity. Long-term follow-up is essential to monitor for complications and optimize outcomes. Prompt intervention, combined with individualized postoperative management, is essential for achieving optimal functional recovery and minimizing the risk of progression or recurrence of SCFE.