Avascular Necrosis of the Humeral Head in Adolescents and Young Adults-Treatment
and Long-Term Outcomes
#MMPMID41262428
Batley MG
; Yellin J
; Lawrence JT
; Wells L
; Williams BA
JB JS Open Access
2025[Oct]; 10
(4
): ? PMID41262428
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BACKGROUND: Currently, there is a dearth of literature regarding the indications
for treatments of humeral head avascular necrosis (AVN) in the pediatric and
young adult population and their long-term outcomes. The purpose of this study
was to report on a consecutive series of patients treated at a single institution
for humeral head AVN to describe diagnostic findings, implemented treatments, and
long-term patient outcomes. METHODS: A retrospective review and cross-sectional
outcomes assessment was performed to identify patients with humeral head AVN
treated at a pediatric hospital between 2011 and 2021. Patient demographics,
treatment strategies, and outcomes were retrospectively analyzed. A
cross-sectional survey was then distributed that included patient-reported
outcome measures and evaluated definitive shoulder treatment. Descriptive
statistics were used to summarize patient characteristics and outcome scores.
RESULTS: We identified 30 shoulders in 21 patients meeting study criteria.
Patients were 16.9 years old at AVN diagnosis and predominantly male (12, 57%).
Diagnosis was prompted by pain in most cases (20, 95%) and often associated with
cancer treatment (12, 57%) or steroid use (10, 48%). Most shoulders were examined
with magnetic resonance imaging (28, 93%) and identified as Stage II at diagnosis
(19, 68%). Shoulders were usually nonoperatively treated initially. Eleven
patients (52%) completed the cross-sectional outcomes assessment at an average of
7.13 years from diagnosis. Notably, 10 shoulders (55.6%) underwent operative
treatment within this time course (28% underwent arthroplasty). Patient-Reported
Outcome Measurement Information System and American Shoulder and Elbow Surgeons
Evaluation score data showed scores within normative ranges for this population
at follow-up. CONCLUSION: This study expands on the limited literature regarding
AVN of the humeral head in young patients. Patients were often treated
nonoperatively through cross-sectional follow-up. Importantly, patients reported
functionality and outcome scores within normative ranges. These results suggest
nonoperative treatment is an effective initial management strategy for AVN of the
humeral head in pediatric patients, but operative treatment may ultimately be
required in a subset of patients. Further work is necessary to determine
appropriate indications and timing of surgical treatment for this condition in
this population. LEVELS OF EVIDENCE: Level III. See Instructions for Authors for
a complete description of levels of evidence.
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