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.

UNASSIGNED: To explore the feasibility and early effectiveness of computer-simulated osteotomy based on the health-side combined with guide plate technique in the treatment of cubitus varus deformity in adolescents.
UNASSIGNED: The clinical data of 23 patients with cubitus varus deformity who met the selection criteria between June 2019 and February 2023 were retrospectively analyzed. There were 17 males and 6 females, ranging in age from 4 to 16 years with an average of 8.5 years. The time from injury to operation was 1-4 years. The angle of distal humerus rotation was defined by humeral head posterior inclination angle using low radiation dose CT to scan the patient\'s upper extremity data at one time, and the preoperative rotation of the distal humerus on the affected side was (33.82±4.39)°. The CT plain scan data were imported into 9yuan3D digital orthopaedic system (V3.34 software) to reconstruct three-dimensional images of both upper extremities. The simulated operation was performed with the healthy upper extremity as the reference, the best osteotomy scheme was planned, overlapped and compared, and the osteotomy guide plate was prepared. The patients were followed up regularly after operation, and the formation of callus in the osteotomy area was observed by X-ray examination. Before and after operation, the carrying angle of both upper extremities (the angle of cubitus valgus was positive, and the angle of cubitus varus was negative) and anteversion angle were measured on X-ray and CT images. At the same time, the flexion and extension range of motion of elbow joint and the external rotation range of motion of upper extremity were measured, and Mayo score was used to evaluate the function of elbow joint.
UNASSIGNED: The operation time ranged from 34 to 46 minutes, with an average of 39 minutes. All patients were followed up 5-26 months, with a mean of 14.9 months. All the incisions healed by first intention after the operation; 2 patients had nail path irritation symptoms after Kirschner wire fixation, which improved after dressing change; no complication such as breakage and loosening of internal fixators occurred after regular X-ray review. Continuous callus formed at the osteotomy end at 4 weeks after operation, and the osteotomy end healed at 8-12 weeks after operation. At last follow-up, the carrying angle, anteversion angle, external rotation range of motion, and extension and flexion range of motion of the elbow joint of the affected side significantly improved when compared with preoperative ones ( P<0.05). Except for the extension range of motion of the healthy elbow joint ( P<0.05), there was no significant difference in other indicators between the two sides ( P>0.05). At last follow-up, the Mayo elbow score was 85-100, with an average of 99.3; 22 cases were excellent, 1 case was good, and the excellent and good rate was 100%.
UNASSIGNED: Computer-simulated osteotomy based on health-side combined with guide plate technique for treating cubitus varus deformity in adolescents can achieve precise osteotomy, which has the advantages of short operation time and easy operation, and the short-term effectiveness is satisfactory.
UNASSIGNED: 探讨基于健侧的计算机模拟截骨联合导板技术治疗青少年肘内翻畸形的可行性及早期临床疗效。.
UNASSIGNED: 回顾分析2019年6月—2023年2月收治且符合选择标准的23例肘内翻畸形患者临床资料。其中男17例，女6例；年龄4～16岁，平均8.5岁。受伤至手术时间1～4年。使用低辐射剂量CT一次性扫描患者双上肢数据，以肱骨头后倾角定义肱骨远端旋转角度，术前患侧肱骨远端旋转（33.82±4.39）°。将CT平扫数据导入9yuan3D数字骨科系统（V3.34）软件，重建双上肢三维图像，以健侧上肢为参考行模拟手术，规划最佳截骨方案，重叠比对，制备截骨导板。术后定期随访，复查X线片观察截骨区骨痂形成情况；手术前后于X线片及CT图像上测量患者双上肢提携角（肘外翻角度为正值，肘内翻角度为负值）、前倾角，同时测量肘关节屈伸活动度及上肢外旋活动度，采用Mayo评分评价肘关节功能。.
UNASSIGNED: 手术时间34～46 min，平均39 min。所有患者均获随访，随访时间5～26个月，平均14.9个月。术后切口均Ⅰ期愈合；2例患者克氏针固定术后出现钉道刺激症状，经换药后好转；定期复查X线片均未发生内固定器械断裂、松动等并发症。术后4周截骨端有连续性骨痂形成，8～12周截骨端愈合。末次随访时，患侧提携角、前倾角、上肢外旋活动度及肘关节伸直、屈曲活动度均较术前显著改善（ P<0.05）；与健侧比较除肘关节伸直活动度差异有统计学意义（ P<0.05）外，其余指标健患侧比较差异均无统计学意义（ P>0.05）。末次随访时，Mayo肘关节评分为85～100分，平均99.3分；获优22例、良1例，优良率100%。.
UNASSIGNED: 基于健侧的计算机模拟截骨联合导板技术治疗青少年肘内翻畸形可实现精准截骨，具有手术时间短、易操作等优势，早期临床效果满意。.

UNASSIGNED: Lesions of the long head of the biceps (LHB) tendon are a prevalent injury that frequently coexists with rotator cuff injuries. This study aimed to assess the effect of supraspinatus (SST) repair with concurrent LHB tenotomy on superior migration of the humeral head. The acromiohumeral distance (AHD) was determined via ultrasound to evaluate the superior migration of the humeral head.
UNASSIGNED: The study population was retrospectively recruited from patients who underwent unilateral arthroscopic repair of isolated degenerative full-thickness SST tears between January 2017 and December 2019. Patients were divided into 2 subgroups based on whether they underwent LHB tenotomies during arthroscopy. While 37 patients underwent arthroscopic single-row SST repair, the other 33 patients underwent arthroscopic single-row SST repair with LHB tenotomy. The subject group consisted of people who had undergone arthroscopic shoulder surgery. Contralateral shoulders without rotator cuff injuries were included in the control group. The AHD and SST thicknesses of patients were examined via the ultrasound in both groups and subgroups.
UNASSIGNED: The mean age in the SST repair group was 55.52 ± 4.58 years (range, 46-63 years), whereas it was 58.24 ± 3.98 (range, 52-73 years) in the SST repair + LHB tenotomy group. In the SST repair group, 57.6% of patients were female and 42.4% were male, whereas 56.8% and 43.2% were in the SST repair + LHB tenotomy group, respectively. The mean body mass index was 28.06 ± 1.31 kg/m2 (range, 25.7-31.2 kg/m2) in the SST repair group and 28.95 ± 1.79 kg/m2 in the SST repair + LHB tenotomy group. Groups were not different for sex, surgery side, dominant side, tear size, and follow-up time; however, the SST repair + LHB tenotomy group had significantly higher mean age and body mass index than the SST repaired group. The mean AHD value and SST thickness were significantly less in both the rotator cuff repair group and the rotator cuff repair + LHB tenotomy group compared to the healthy shoulder. The mean AHD value was significantly lower in the SST repaired + LHB tenotomy group than in the SST repair group (P = .02).
UNASSIGNED: The AHD was narrowed in patients who underwent LHB tenotomy and radiologically demonstrated the depressor effect of the LHB tendon on the humeral head. As a secondary outcome, we demonstrated that regardless of tenotomy, AHD could not be restored in patients who underwent arthroscopic single-row SST repair.

UNASSIGNED: Anatomic restoration of the humeral head is critical for successful shoulder replacement. Accurate measurements of the humeral head are essential for anatomic substitution.
UNASSIGNED: To evaluate whether a best-fit circle of the humeral head, as determined from different projections of plain radiographs, can predict the humeral head implant size for either the left or right shoulder.
UNASSIGNED: Descriptive laboratory study.
UNASSIGNED: Bilateral shoulder radiographs of 200 patients without arthropathy or other abnormal findings of the humeral head were evaluated. The best-fit circle was obtained based on 3 points: the medial and lateral endpoints of the anatomic neck and the lateral cortex below the greater tuberosity. This circle was drawn on 5 different radiographic projections (shoulder anteroposterior [AP], glenoid AP, outlet, axillary, and 30° caudal tilt) of the left and right shoulders of each patient, and the radius of each circle was measured. Agreement in the best-fit circle radius between the left and right shoulders was statistically analyzed using the intraclass correlation coefficient (ICC). There were 2 independent blinded observers who performed each measurement twice to evaluate inter- and intraobserver reliability.
UNASSIGNED: Overall agreement in the radius between the right and left shoulders was excellent (all ICCs ≥0.990). The ICCs according to the radiographic view were 0.990 (95% CI, 0.986-0.993) for shoulder AP, 0.992 (95% CI, 0.989-0.995) for glenoid AP, 0.996 (95% CI, 0.994-0.997) for outlet, 0.994 (95% CI, 0.991-0.996) for axillary, and 0.993 (95% CI, 0.990-0.995) for 30° caudal tilt. Interobserver ICCs demonstrated a high level of precision: 0.987 (95% CI, 0.978-0.993) for shoulder AP, 0.986 (95% CI, 0.974-0.992) for glenoid AP, 0.974 (95% CI, 0.954-0.985) for outlet, 0.991 (95% CI, 0.984-0.995) for axillary, and 0.987 (95% CI, 0.977-0.993) for 30° caudal tilt. Intraobserver ICCs demonstrated excellent test-retest reliability: 0.983 (95% CI, 0.970-0.991) for shoulder AP, 0.989 (95% CI, 0.980-0.994) for glenoid AP, 0.987 (95% CI, 0.978-0.993) for outlet, 0.985 (95% CI, 0.973-0.991) for axillary, and 0.970 (95% CI, 0.947-0.983) for 30° caudal tilt.
UNASSIGNED: The best-fit circle to calculate the ideal size of a humeral head implant was able to be determined from different projections of plain radiographs.
UNASSIGNED: Anatomic restoration of a deformed humeral head can be achieved using the best-fit circle of the contralateral humeral head as obtained from plain radiographs. This method can facilitate preoperative planning and postoperative evaluation in the anatomic restoration of the shoulder to avoid the problems of overstuffing.

The humeral head is considered the second most common site for osteonecrosis to occur after the femoral head. As seen in the femoral head, the circulatory implications characteristic of this condition are attributable to the interaction between a genetic predisposition and the exposure to certain risk factors. There is no consensus regarding the pathogenesis of osteonecrosis, yet the final common pathway results in disrupted blood supply, increased intraosseous pressure, and bone death. Disease staging using radiography and magnetic resonance imaging is predictive of disease progression and can help the orthopedic surgeon to guide treatment. Although there is a myriad of treatment modalities, there is a lack of high-quality evidence to conclude what is the most appropriate treatment option for each stage of humeral head osteonecrosis. Nonoperative treatment is the preferred option in early-stage disease, and it may prevent disease progression. Nonetheless, in some cases, disease progression occurs despite nonoperative measures, and surgical treatment is required. The purpose of this article is to provide an updated review of the available evidence on risk factors, diagnosis, and treatment of atraumatic humeral head osteonecrosis.

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