There is separation of the proximal femoral epiphysis through the growth plate so that the head of the femur becomes displaced medially and posteriorly. Most cases (80 percent) result from a progressive chronic slip of the femoral epiphysis and 20 percent have the injury acutely following a traumatic event. It occurs in early adolescene and is most common in obese males. The presentation is a painful limp that may last for months. The pain commonly is referred to the thigh or even the medial side of knee. There is usually a limitation of internal rotation and abduction of the hip. The diagnosis is confirmed by X-ray.
Treatment is similiar to that of a fracture of the neck of the femur. If there has been an acute injury, traction may help and, in chronic cases, pinning the slip as it lies is preferred. Reduction of the chronic slip may lead to avascular necrosis of the femoral head. About 30 percent of patient have bilateral involvement so that slipping of the opposite side may occur and this could be 1-2 years after the initial injury.
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