Page 131 - ASOP ROT Study Guide

Clinical presentation
In this condition the child has a limp which may not be particularly uncomfortable, but there may be
pain radiating to the knee (following the sensory distribution of theobturator nerve). Any child with knee
pain must have their hip examined. The slip may occur acutely or it may be preceded by many months
of discomfort without clinical or radiological signs. All young adolescents with a painful hip must be
regarded as having this condition until it is clinically and radiologically excluded. Radiographs must
include a lateral view or minor degrees of slippage may be missed.

Management
Treatment is surgical. If the slippage is minor, the hip should be pinned in its new deformed position.
If the slippage is major, a gentle attempt to replace the head on the neck by manipulation may be
attempted although the risk of avascular necrosis is high. The other hip should be observed, using
radiography at regular intervals, and pinned if any suspicion of slippage arises. The pins are best
removed after fusion of the epiphysis at around eighteen years of age.