# Herring — Modified Herring lateral pillar classification of Legg-Calve-Perthes disease

> Per-hip prognostic morphology assigned only on a technically adequate true AP radiograph during the fragmentation stage. The modified system separates A, B, B/C border and C by lateral-pillar height and ossification; age at onset remains an independent input, and the code alone neither diagnoses disease nor prescribes or excludes containment treatment.

**Situação:** vigente · **Órgão:** Pediatria · **Órgão emissor:** Herring et al. / Legg-Calve-Perthes Study Group · **Versão:** 1992 original; modified four-group system and outcome study 2004; current POSNA care boundary · **Ano:** 1992

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: XR
- Fonte primária: Kollitz KM, Gee AO. Classifications in Brief: The Herring Lateral Pillar Classification for Legg-Calve-Perthes Disease (2013) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3676599/
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
Classify one hip only on an adequate true AP view during fragmentation. Preserve the raw height and B/C morphology, age at onset, timing and uncertainty; use the code as a historical prognostic descriptor, never as an autonomous treatment rule.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| A | Group A | Modified Herring group A: on an adequate true AP radiograph during the fragmentation stage, the lateral pillar is uninvolved and retains full height without the density or ossification change that defines involvement. Classify each hip and timepoint separately. | The Herring group alone does not select treatment. Group A had uniformly favorable skeletal-maturity morphology in the multicenter cohort, but current care still integrates age at onset, stage, extrusion, range of motion, symptoms and containment; do not use A as an automatic discharge or no-follow-up rule. | In the published modified-classification outcome table, 100% of group-A hips reached Stulberg I or II at skeletal maturity. This historical cohort distribution is a group-level prognostic descriptor, not a guaranteed individual outcome. | Herring et al. 2004 Part I, PMID 15466719 and DOI 10.2106/00004623-200410000-00001, modified classification; Kollitz and Gee 2013, PMC3676599, Table 2, group A criteria and Stulberg distribution; POSNA LCP Study Guide, current multifactorial care context. | ✓ |
| B | Group B | Modified Herring group B: during fragmentation, more than 50% of lateral-pillar height is retained and none of the B/C border morphologies (thin or narrow pillar, poor ossification, or depression to about exactly one-half height) is present. | Age modifies the treatment evidence. In the 2004 prospective study, group-B hips with onset after age 8 had better outcomes after operative containment, whereas group-B hips with onset at age 8 or younger did similarly well with operative and nonoperative care. This does not create an automatic osteotomy rule: current decisions also require stage, extrusion, motion, containment feasibility and specialist judgment. | The multicenter outcome table reported 67% Stulberg I or II, 27% Stulberg III and 6% Stulberg IV or V for group B. Age at onset is an independent prognostic input, so these pooled historical proportions are not personal probabilities. | Kollitz and Gee 2013, PMC3676599, Table 2, group B >50% height and Stulberg distribution; Herring et al. 2004 Part II, PMID 15466720 and DOI 10.2106/00004623-200410000-00002, age-stratified operative versus nonoperative results; POSNA LCP Study Guide, current containment context. | ✓ |
| B/C | Group B/C border | Modified Herring B/C border group: the fragmented lateral pillar is at or above the one-half-height boundary but has a border morphology—more than half height with a thin or narrow pillar, at least about half height with poor ossification, or depression to about exactly 50% of the central-pillar height. Do not hard-code the conflicting millimetre/centimetre width rendered in secondary sources. | In the prospective multicenter cohort, B/C hips with onset after age 8 had better outcomes with operative containment. The finding is age- and cohort-specific, not a grade-only prescription; current planning also depends on early timing, extrusion, range of motion, skeletal maturity, containment feasibility and patient-specific orthopedic assessment. | The published table reported 28% Stulberg I or II, 43% Stulberg III and 30% Stulberg IV or V for B/C (rounding totals approximately 101%). This is an intermediate historical group distribution and not an individualized probability. | Herring et al. 2004 Part I, PMID 15466719, modified B/C morphologies and reliability; Kollitz and Gee 2013, PMC3676599, Tables 1-2, B/C criteria and Stulberg distribution; Herring et al. 2004 Part II, PMID 15466720, age-treatment interaction. | ✓ |
| C | Group C | Modified Herring group C: less than 50% of lateral-pillar height is retained during the fragmentation stage. Exactly one-half belongs at the B/C boundary rather than C; if image quality cannot resolve that boundary, return uncertainty instead of rounding. | Group C had the least favorable outcomes and no demonstrated operative-versus-nonoperative difference in the 2004 cohort. That result does not make C a no-treatment or futility label: current care remains individualized around age, stage, symptoms, extrusion, motion, containment feasibility and later reconstructive or salvage needs. | The published table reported 13% Stulberg II, 52% Stulberg III and 35% Stulberg IV or V for group C. These historical skeletal-maturity outcomes describe a cohort and must not be used as a deterministic disability or treatment forecast. | Kollitz and Gee 2013, PMC3676599, Table 2, group C <50% height and Stulberg distribution; Herring et al. 2004 Part II, PMID 15466720 and DOI 10.2106/00004623-200410000-00002, least-favorable results and no demonstrated treatment difference; POSNA LCP Study Guide, current individualized care context. | ✓ |

### Citações por categoria
- **A**: Kollitz KM, Gee AO. Classifications in Brief: The Herring Lateral Pillar Classification for Legg-Calve-Perthes Disease (2013) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3676599/ · Herring et al. 2004 Part I, PMID 15466719 and DOI 10.2106/00004623-200410000-00001, modified classification; Kollitz and Gee 2013, PMC3676599, Table 2, group A criteria and Stulberg distribution; POSNA LCP Study Guide, current multifactorial care context.
- **B**: Kollitz KM, Gee AO. Classifications in Brief: The Herring Lateral Pillar Classification for Legg-Calve-Perthes Disease (2013) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3676599/ · Kollitz and Gee 2013, PMC3676599, Table 2, group B >50% height and Stulberg distribution; Herring et al. 2004 Part II, PMID 15466720 and DOI 10.2106/00004623-200410000-00002, age-stratified operative versus nonoperative results; POSNA LCP Study Guide, current containment context.
- **B/C**: Kollitz KM, Gee AO. Classifications in Brief: The Herring Lateral Pillar Classification for Legg-Calve-Perthes Disease (2013) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3676599/ · Herring et al. 2004 Part I, PMID 15466719, modified B/C morphologies and reliability; Kollitz and Gee 2013, PMC3676599, Tables 1-2, B/C criteria and Stulberg distribution; Herring et al. 2004 Part II, PMID 15466720, age-treatment interaction.
- **C**: Kollitz KM, Gee AO. Classifications in Brief: The Herring Lateral Pillar Classification for Legg-Calve-Perthes Disease (2013) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3676599/ · Kollitz and Gee 2013, PMC3676599, Table 2, group C <50% height and Stulberg distribution; Herring et al. 2004 Part II, PMID 15466720 and DOI 10.2106/00004623-200410000-00002, least-favorable results and no demonstrated treatment difference; POSNA LCP Study Guide, current individualized care context.

## Referências cruzadas
- _fronteira compartilhada_ → [Graf — Graf ultrasound classification of developmental dysplasia of the hip](https://radcommons.laudos.ai/systems/graf-ddh.md) — Both are pediatric hip systems: Graf screens the infant hip on ultrasound, Herring prognosticates Legg-Calve-Perthes on radiographs.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2004-10-01 | revised | The prospective multicenter study published the modified four-group A, B, B/C and C system, formal reliability testing and age-stratified outcome evidence. | confirmed |
| 2004-01-01 | revised | Modified lateral pillar classification adds the B/C border group. | confirmed |
| 1992-01-01 | published | Herring and colleagues introduced the three-group lateral-pillar classification for Legg-Calve-Perthes disease during fragmentation. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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