Legg-Calve-Perthes disease and slipped capital femoral epiphysis Quiz: Ace Your Exams

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A 15-year-old boy presents to the emergency department for evaluation of pain with walking and a limp. His symptoms have progressively worsened over the past two weeks but became more severe today after stepping awkwardly off a curb. There is no significant medical history. The adolescent had a cold last week but has otherwise been in his usual state of health. Temperature is 37.4°C (99.4°F), blood pressure is 132/78 mmHg, heart rate is 110 beats per minute, respiratory rate is 18 breaths per minute, and oxygen saturation is 98% on room air. On exam, weight is 98 kg (216 lbs.; > 99th percentile for age) and height is 168 cm (5 ft 6 in). The patient appears to be in pain. Physical examination reveals tenderness to palpation over the hip, and the leg externally rotates with passive hip flexion. Which of the following is the best next step in diagnosis?

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Plain radiographs of the hip

Magnetic resonance imaging (MRI) of the hip

Ultrasound of the hip

Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)

Hip arthrocentesis