title: Lateral and posterior pillar grade changes during the treatment of Perthes disease in older patients using skin traction and range of motion exercises.
abstract: BACKGROUND
  The lateral pillar (LP) grade changes detected during treatment periods have received a lot of attention recently. Lappin et al. reported LP collapses in 92 of 275 (33%) patients during the treatment, but did not provide information for comparing treatment methods and age of onset of the disease. The purpose of this study was to review radiological changes in LP grade in older patients with Perthes disease during 20 months of treatment with skin traction and ROM exercises. We have also reported any grade changes in the posterior pillar (PP) classification.
  
  
  METHODS
  Twenty-one patients with unilateral disease who were 9 years or older at the onset of symptoms had been followed until skeletal maturity.
  
  
  RESULTS
  Out of 21 older patients with Perthes disease, our study had two (9.5%) who experienced LP collapse and two (9.5%) who experienced PP collapse during the first 20 months of treatment. The average time from onset to hospitalization in hips, initially classified as LP group C and PP group C, was significantly longer than in LP and PP groups A and B. The LP collapse in two hips and PP collapse in two hips occurred during months 4-8 of treatment. On the other hand, of the patients allowed to ambulate with the Pogo stick orthosis from months 8 to 12 and without a brace from months 10 to 15, none had a collapse of their LPs or PPs during these periods.
  
  
  CONCLUSIONS
  Lappin et al. reported that 92 of 275 patients (33%) who were managed conservatively in several hospitals experienced LP collapse during their treatment periods. Our results suggest that older patients with this disease treated with skin traction and ROM exercises rarely suffer a LP collapse, as compared with the Lappin et al. report.
authors.affiliation: Okayama University Hospital of Medicine and Dentistry, 2-5-1 Shikata-cho, Okayama, Japan. yoshihisa64@hotmail.com
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Sugimoto
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Akazawa
authors.forename: Shigeru
authors.initials: S
authors.lastname: Mitani
authors.forename: Masato
authors.initials: M
authors.lastname: Tanaka
authors.forename: Tadashi
authors.initials: T
authors.lastname: Nakagomi
authors.forename: Koji
authors.initials: K
authors.lastname: Asaumi
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Ozaki
mesh_terms: D000293:Adolescent; D000367:Age Factors; D017668:Age of Onset; D002648:Child; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D011237:Predictive Value of Tests; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D014143:Traction / Q000379:methods*; D016896:Treatment Outcome