This 1992 paper by Herring et al. introduces the lateral pillar classification for Legg-Calvé-Perthes disease. It asks whether grading lateral pillar height loss during the fragmentation stage can predict final femoral head shape at skeletal maturity. 93 brace-treated hips followed to skeletal maturity were studied, with Stulberg classification as the outcome.
The Catterall classification dominated Perthes management before this paper, but its interobserver reliability was only 0.42 — too poor to support meaningful treatment comparisons across centers. Herring's lateral pillar system gave clinicians a reproducible, fragmentation-stage tool that directly predicts femoral head shape at maturity.
When you see a child in fragmentation, classify the lateral pillar and check age: Group A patients do well with observation alone. Group B patients under 9 generally heal well with bracing. Group B patients 9 or older are the pivotal group where containment treatment. Surgical or orthotic. Has demonstrated benefit in subsequent trials.
Group C patients face poor outcomes in both age groups; early recognition allows timely surgical planning rather than false reassurance from a young age at onset. This paper's age-9 threshold and lateral pillar grouping remain the foundation of every contemporary Perthes treatment algorithm and were the stratification backbone of the landmark Herring multicenter RCT that followed.
This 1992 paper by Herring et al. introduces the lateral pillar classification for Legg-Calvé-Perthes disease. It asks whether grading lateral pillar height loss during the fragmentation stage can predict final femoral head shape at skeletal maturity. 93 brace-treated hips followed to skeletal maturity were studied, with Stulberg classification as the outcome.
The Catterall classification dominated Perthes management before this paper, but its interobserver reliability was only 0.42 — too poor to support meaningful treatment comparisons across centers. Herring's lateral pillar system gave clinicians a reproducible, fragmentation-stage tool that directly predicts femoral head shape at maturity.
When you see a child in fragmentation, classify the lateral pillar and check age: Group A patients do well with observation alone. Group B patients under 9 generally heal well with bracing. Group B patients 9 or older are the pivotal group where containment treatment. Surgical or orthotic. Has demonstrated benefit in subsequent trials.
Group C patients face poor outcomes in both age groups; early recognition allows timely surgical planning rather than false reassurance from a young age at onset. This paper's age-9 threshold and lateral pillar grouping remain the foundation of every contemporary Perthes treatment algorithm and were the stratification backbone of the landmark Herring multicenter RCT that followed.