What should you know about Legg-Calvé-Perthes vs SCFE?

Perthes often develops gradually and may cause a limp, hip or groin discomfort, or pain referred to the thigh or knee. The child may lose hip movement, especially turning the leg inward. SCFE can also cause limping and pain in the hip, thigh, or knee, but the hip may become stiff and the leg may rest turned outward. SCFE can be stable, with some ability to bear weight, or unstable, when walking is not possible. Symptoms can overlap, so examination and hip imaging are needed to distinguish them.

Stop sport, running, and jumping if a child has a new limp or hip, thigh, or knee pain. Do not encourage the child to walk through symptoms. Arrange medical assessment promptly; the clinician may compare both hips, check movement, and request X-rays. Management depends on the diagnosis, age, hip position, symptoms, and ability to bear weight. It may include activity limits, protected weight-bearing, physiotherapy, or surgery. Fracture fixation surgery is a different procedure, but similar fixation principles may be discussed when a hip condition needs stabilisation.

Seek urgent care if a child suddenly cannot bear weight, has severe hip or thigh pain, or develops marked stiffness after a new symptom. A new limp without an obvious minor cause also deserves prompt evaluation. Do not use the absence of fever to dismiss a serious hip problem; SCFE can present without infection signs.

Which diagnosis fits the examination and imaging? Is weight-bearing safe? What activities are restricted, and does the other hip need assessment?