A 7-year-old boy with Legg-Calvé-Perthes disease has a lateral pillar classification Group B (50% lateral pillar height maintained). According to the current evidence-based treatment guidelines (Herring 2004 and update), the recommended treatment is:

• A Conservative management with physiotherapy regardless of age
• B Surgical containment (femoral varus osteotomy or Salter innominate osteotomy) in children >8 years at presentation ✓
• C Observation alone as Group B has a universally good prognosis
• D Core decompression of the femoral head to prevent collapse

Explanation

Herring's lateral pillar classification divides the femoral head into thirds: the lateral pillar collapse guides prognosis and treatment. Group B (lateral pillar maintains >50% of normal height at the fragmentation stage) has an intermediate prognosis. Evidence from the Herring 2004 multicenter study shows that children with Group B disease aged >8 years at onset have significantly better outcomes with surgical containment (varus osteotomy or Salter/triple innominate osteotomy) than with orthotic or physiotherapy alone. Children <8 years with Group B and children with Group A generally do well conservatively. Group C (>50% lateral pillar loss) has a poor prognosis even with surgery.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.