{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T14:19:37Z","timestamp":1789827577383,"version":"4.0.1"},"reference-count":36,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2024,5,19]],"date-time":"2024-05-19T00:00:00Z","timestamp":1716076800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Children's Orthopaedics"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>PubMed, Ovid MEDLINE, and Scopus were screened with the terms \u201costeonecrosis,\u201d \u201cavascular necrosis,\u201d \u201cpediatric,\u201d and \u201cproximal humerus\u201d 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence:<\/jats:title>\n                    <jats:p>IV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/18632521241254708","type":"journal-article","created":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T01:39:58Z","timestamp":1716169198000},"page":"432-440","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Management of osteonecrosis of the humeral head in the pediatric population: A systematic review"],"prefix":"10.1177","volume":"18","author":[{"given":"Vineet M","family":"Desai","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"},{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akbar N","family":"Syed","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan","family":"Batley","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Wells","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6247-4146","authenticated-orcid":false,"given":"Brendan A","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,5,19]]},"reference":[{"key":"bibr1-18632521241254708","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2006.01.025"},{"key":"bibr2-18632521241254708","doi-asserted-by":"publisher","DOI":"10.1053\/sarh.2002.33724b"},{"key":"bibr3-18632521241254708","doi-asserted-by":"publisher","DOI":"10.1016\/S0049-0172(05)80026-5"},{"key":"bibr4-18632521241254708","doi-asserted-by":"publisher","DOI":"10.1007\/s12178-015-9277-8"},{"key":"bibr5-18632521241254708","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-016-4169-z"},{"key":"bibr6-18632521241254708","doi-asserted-by":"publisher","DOI":"10.1111\/os.12788"},{"issue":"1","key":"bibr7-18632521241254708","first-page":"1","volume":"2","author":"Ismael MQ","year":"2006","journal-title":"Al-Khwarizmi Eng J"},{"key":"bibr8-18632521241254708","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-199711000-00006"},{"key":"bibr9-18632521241254708","doi-asserted-by":"publisher","DOI":"10.2174\/1874325000903010032"},{"key":"bibr10-18632521241254708","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-015-3060-8"},{"key":"bibr11-18632521241254708","doi-asserted-by":"publisher","DOI":"10.1016\/j.morpho.2020.12.010"},{"key":"bibr12-18632521241254708","doi-asserted-by":"publisher","DOI":"10.1016\/S1058-2746(96)80066-8"},{"key":"bibr13-18632521241254708","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199810000-00027"},{"key":"bibr14-18632521241254708","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2008.10.016"},{"key":"bibr15-18632521241254708","unstructured":"Sterne JAC, Higgins JPT, Reeves BC. 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