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UNASSIGNED: Humeral head osteonecrosis in the pediatric patients most often occurs in patients with underlying hemoglobinopathies, exposure to chronic corticosteroids, or after trauma. The purpose of this study was to perform a systematic review evaluating the prevalence, clinical characteristics, and management of humeral head osteonecrosis in the pediatric population.
UNASSIGNED: PubMed, Ovid MEDLINE, and Scopus were screened with the terms \"osteonecrosis,\" \"avascular necrosis,\" \"pediatric,\" and \"proximal humerus\" on January 10, 2024. A total of 218 studies were screened, and 74 studies were evaluated for eligibility. Studies that reported on the prevalence and/or management of pediatric humeral head osteonecrosis were included. The systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.
UNASSIGNED: Twelve studies met inclusion criteria: four retrospective case series, three prospective case series, one retrospective cohort study, one retrospective case-control study, and three case reports. A majority of the studies (67%) discussed chemotherapy-induced osteonecrosis of the humeral head. A total of 77 patients (106 shoulders) with humeral head osteonecrosis were identified. The overall prevalence of osteonecrosis of the humeral head across eight studies examining at-risk populations (underlying hemoglobinopathies or undergoing chemotherapy) was 2%. Intra-articular steroid injections, physical therapy, and activity modification are effective conservative management strategies. Additionally, core decompression and hemiarthroplasty are surgical treatment options.
UNASSIGNED: The prevalence of osteonecrosis of the humeral head is low even among at-risk populations with associated medical conditions. A variety of conservative and surgical treatment options have been described, but no comparative evaluations of these modalities has been conducted.
UNASSIGNED: IV.

UNASSIGNED: Large osteochondral lesions of the humeral head can result from locked posterior dislocations, avascular necrosis, and osteochondritis dissecans. Fresh osteochondral allograft (OCA) transplantation is a treatment option for young patients with focal osteochondral defects of the humeral head. The purpose of this case series was to assess graft survivorship, subjective patient-reported outcomes, and satisfaction among 7 patients who underwent OCA transplantation of the humeral head.
UNASSIGNED: We identified 7 patients who underwent humeral head OCA transplantation between 2008 and 2017. A custom questionnaire including the American Shoulder and Elbow Surgeons score, Quick Disabilities of the Arm, Shoulder, and Hand score (QuickDash), Likert satisfaction, and reoperations was mailed to each patient. Clinical failure was defined as further surgery that involved removal of the allograft.
UNASSIGNED: Median follow-up duration was 10 years (range, 4.6 to 13.5 years) with a median age of 21.6 years (range, 18.5 to 43.5 years). Most patients (86%) reported improved function and reduced pain. At the final follow-up, 71% of patients reported ongoing problems with their shoulder including pain, stiffness, clicking/grinding, limited range of motion, and instability. Return to recreational activities was high at 86% but 43% expressed limitations with activity due to their shoulder. Overall satisfaction was high at 71% with mean American Shoulder and Elbow Surgeons and QuickDASH scores at 62.4 and 29.2, respectively. Reoperation after OCA occurred in 1 patient (14%).
UNASSIGNED: Among this case series of 7 patients who underwent OCA transplantation of the humeral head, patient satisfaction was high at 10-year follow-up and most returned to recreational activity although most also had persistent shoulder symptoms.

BACKGROUND: The indication for shoulder resurfacing arthroplasty is controversial, and survival of these implants is somewhat inconsistent. This study aimed to evaluate the long-term survivorship of resurfacing humeral head implants (RHHIs) and determine risk factors for complications and revisions.
METHODS: This retrospective cohort study consisted of 275 cases and two types of RHHIs. The survival rate was evaluated using the Kaplan-Meier method and Cox regression for risk factor analysis. Demographic factors were studied, and the change in the humerus centre of rotation (COR) was measured.
RESULTS: The mean follow-up time was 8.7 years (SD 2.7 months, range 2.8-15.9 years). The mean age of the patients was 67.6 years (SD 9.6, range 33.5-84.9). Ten-year cumulative RHHI survival was 94.1%. The cumulative estimate without any complication was 98.9% at 5 years, 80.0% at 10 years and at 15 years it was 61.5%. The most common complication was persistent pain in 13.8% of the RHHIs. The risk factors for complications and revisions were implant type, preoperative conditions and change of COR > 5 mm.
CONCLUSIONS: RRHIs showed excellent long-term survival, but many complications were found. The most common complication was persistent pain, which seemed to be caused by a change of COR and was more related to one type of implant.

BACKGROUND: Severe trauma is a frequent condition encountered in Emergency department (ED) in which vital prognosis can easily be engaged. This condition could be responsible for unusual injuries occurrence. Emergency physician must be aware of these situations where adequate management is urgently required. We report a case of e 45-year-old patient who was admitted to the ED after a high velocity road traffic accident resulting in multiple injuries and fracture dislocation and migrating humeral head into intra thoracic position.
METHODS: We report the clinical case of a patient aged 45 years without medical history admitted to the ED after being involved in a high-velocity road traffic accident. On clinical presentation, the patient was dyspneic and desaturated on ambient air room, he presented moreover clinical signs of blunt right shoulder trauma and deformation of the 2 thighs. Final screening of injuries by radiological and a tomographic exams retained a polytrauma status with fracture dislocation and migration of humeral head, homolateral hemothorax and double femur fracture. Patient was managed by multidisciplinary surgical approaches. Discusssion et conclusion: We illustrated by this case a very rare post trauma condition represented by a fracture dislocation of the humeral head resulting in an intrathoracic migration and a homolateral hemothorax. This diagnosis was reported only a few times by the literature within last decades and management suffers from lack of treatment guidelines, which remain team-dependent. At the very early stage of management and before surgical step, emergency physician must be aware of the possibility of this clinical condition with evolution into some threatening clinical presentations with specific management.

Pseudohypoparathyroidism is a rare disorder characterized by end-organ resistance to intact parathyroid hormone (PTH) and concomitant laboratory findings of hypocalcemia and hyperphosphatemia. Radiologic evidence of the disease may manifest as a variety of bone abnormalities. This case describes an 11-year-old female with a history of repaired bilateral slipped capital femoral epiphysis who presented with a limited range of motion of the bilateral upper extremities. Laboratory findings were consistent with pseudohypoparathyroidism. Radiographs revealed subchondral resorption of bilateral clavicular heads and multiple ribs and band lucencies of proximal humeral metaphyses, along with vara deformity and inferior subluxation of the humeral heads. This presentation adds to the spectrum of potential radiographic manifestations of pseudohypoparathyroidism.

UNASSIGNED: The osteonecrosis and the collapse of the humeral head may have many risk factors such as trauma, alcoholism, metabolic diseases, and corticosteroid therapy. Otherwise, it was described as a rare complication of shoulder arthroscopy in the past few years.
UNASSIGNED: We report the case of a 65-year-old right-handed woman who had a rotator cuff tear of the right shoulder. She underwent a double-row arthroscopic repair. Six months later she had an intense shoulder pain, with radiological and MRI signs of humeral head osteonecrosis. The patient had a reverse total shoulder arthroplasty.
UNASSIGNED: The aim of this case report is to underline the diagnostic particularities of this complication, and to shed light on the pathogenesis of the interruption of blood supply in the humeral head following rotator cuff repair. We also discuss the management of this complication with reverse total shoulder arthroplasty.

BACKGROUND: The shoulder rotator cuff (RC) is crucial to shoulder function and involvement in shoulder pathology. RC tears have been extensively studied, and several classifications have been devised to quantify their magnitude. Various RC measurement techniques were introduced previously, utilizing cadaveric specimens, X-rays, CT scans, and MRI with different results published regarding humeral heads\' different plane diameters and the correlation to age, gender, and height. There are very few studies measuring RC length in the general population.
OBJECTIVE: We aimed to assess the geometrical relation between rotator cuff tendon length and humeral head sagittal and axial diameters.
METHODS: A total of 100 shoulder MRI scans of labral tear-suspected patients were reviewed, and the geometrical parameters of the rotator cuff length and proximal humerus sagittal and axial diameters were measured.
RESULTS: The healthy population has wide variability in humeral diameter and rotator cuff length. We found a high correlation between humeral head sagittal and axial plane diameters and the rotator cuff tendon dimension. The orthogonal plane diameters disagree with the humeral head being round but rather spheric. The rotator cuff length changes according to the patient\'s gender and height.
CONCLUSIONS: This is a novel method for rotator cuff measurement, description, and classification according to the percentage of tear instead of length (cm). This method is more clinically oriented and relevant than most other previous methods.

BACKGROUND: The humeral head is the second most common site of osteonecrosis, after the femoral head. However, compared to osteonecrosis of the femoral head (ONFH), epidemiological information on osteonecrosis of the humeral head (ONHH) is scarce. We hypothesised that different biomechanical properties of the shoulder from the hip joint might present different epidemiological characteristics of ONHH from those of the ONFH. To evaluate epidemiological differences, we compared trends in the surgical treatment of ONHH and ONFH using the nationwide medical claims database of the Republic of Korea (ROK).
METHODS: We analysed epidemiological data from the Health Insurance Review and Assessment (HIRA) database of the ROK between 2008 and 2018. HIRA database contains almost all medical information in an anonymised form, including demographics, diagnoses, and types of surgical procedures, generated through healthcare practices in ROK. The annual incidence rates of ONHH and ONFH were calculated based on the total number of the general population. Demographics, annual incidence, and the proportion of post-traumatic osteonecrosis and surgical procedures were compared according to the anatomical site and the affected year.
RESULTS: The total number of patients treated for ONHH and ONFH during the study period was 1,028 and 66,260, respectively. Although the incidence of ONHH increased, it is a relatively rare disease compared to ONFH. ONHH occurred more frequently in females, while ONFH occurred predominantly in male patients (p < 0.001). Surgical treatment for ONHH was most frequently performed in older patients (63.7%), whereas middle-aged patients had the largest proportion of ONFH (48.9%, p < 0.001). The proportion of post-traumatic osteonecrosis was significantly higher in the ONHH (5.1%) than in the ONFH (1.9%, p < 0.001). Arthroplasty was performed more frequently in the ONHH (96.0%) than in the ONFH (92.9%, p < 0.001).
CONCLUSIONS: Despite the anatomical similarities between the hip and shoulder joints, the different biomechanical properties, such as weight-bearing functions, might cause epidemiological differences between ONHH and ONFH.

Background and Objectives: The goal of this study was to evaluate the functional outcomes of patient treatment using an allograft after chronic locked posterior shoulder dislocation associated with a bony defect of the upper edge of the humerus that involves 25-50% of the articular surfaces. Materials and Methods: A total of 20 patients were included in this study. Electrocution was the cause of injury in eight patients; in ten patients, the cause was direct trauma; and in two patients, the cause of injury was a fall due to hypoglycemic coma. A standard deltoid pectoral approach was used and a fresh-frozen osteochondral allograft of the femoral condyle was applied. In evaluating the results, Constant\'s scoring scale was used. Results: The average value of Constant\'s point scale for the operated shoulder is 84.14 points. This result is good according to the average value of Constant\'s point scale. Conclusions: Patients with locked chronic posterior dislocation in combination with a bony defect of the humeral head that covers 25-50% of the articular surface, in our opinion, should be treated using bone allografts rather than non-anatomical reconstruction methods.