Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 May 19;18(4):432-440.
doi: 10.1177/18632521241254708. eCollection 2024 Aug.

Management of osteonecrosis of the humeral head in the pediatric population: A systematic review

Vineet M Desai  1   2 , Akbar N Syed  1 , Morgan Batley  1 , Lawrence Wells  1 , Brendan A Williams  1
Affiliations
Review

Management of osteonecrosis of the humeral head in the pediatric population: A systematic review

Vineet M Desai et al. J Child Orthop. .

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Level of evidence: IV.

Keywords: Humeral head; avascular necrosis; osteonecrosis; pediatric.

PubMed Disclaimer

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Study selection flowchart using PRISMA guidelines.
See this image and copyright information in PMC

References

    1. Lafforgue P. Pathophysiology and natural history of avascular necrosis of bone. Joint Bone Spine 2006; 73(5): 500–507. - PubMed
    1. Assouline-Dayan Y, Chang C, Greenspan A, et al.. Pathogenesis and natural history of osteonecrosis. Semin Arthritis Rheum 2002; 32(2): 94–124. - PubMed
    1. Chang CC, Greenspan A, Gershwin ME. Osteonecrosis: current perspectives on pathogenesis and treatment. Semin Arthritis Rheum 1993; 23(1): 47–69. - PubMed
    1. Shah KN, Racine J, Jones LC, et al.. Pathophysiology and risk factors for osteonecrosis. Curr Rev Musculoskelet Med 2015; 8(3): 201–209. - PMC - PubMed
    1. Franceschi F, Franceschetti E, Paciotti M, et al.. Surgical management of osteonecrosis of the humeral head: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25(10): 3270–3278. - PubMed

LinkOut - more resources