Shoulder Resources

Shoulder AVN (R) Shoulder AVN (R)


Avascular necrosis of the humerus

Anatomy
The main blood supply to the humeral head is from a branch from the anterior circumflex humeral artery.

Epidemiology
Rate after 4 part proximal humeral fracture from 21-75%.

Pathology
The central superior aspect of the humeral head is usually affected.
Creeping substitution may occur more frequently in the humeral head than in the femoral head.

Treatment of AVN
Range of motion and periarticular muscle strengthening exercises are necessary to maintain movement and prevent adhesive capsulitis.
Core decompression can be used with good or excellent results in Ficat stage I and II disease.
When there is collapse of the humeral head, with pain and loss of function, arthroplasty is indicated. Glenoid replacement is necessary only if the glenoid is degenerated.

Prognosis of AVN
With stable fixation, revascularization of the humeral head is possible.
Gerber has found that patients with AVN after humeral fracture may have results equivalent to a primary humeral arthroplasty, provided that fixation is anatomical. If it is not, the Constant score drops from 65 to 41.

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