Avascular Necrosis of the Humeral Head in Adolescents and Young Adults-Treatment and Long-Term Outcomes.
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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.