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Osteonecrosis of the Humeral Head

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Osteonecrosis

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Abstract

Osteonecrosis of the humeral head (ONHH) is thought to occur when the vascularity of the proximal part of the humerus is impaired. An ascending branch of the anterior circumflex artery on the anterolateral aspect of the humeral head is a principal blood supply to the humeral head (Fig. 54.1). The ascending branch of the anterior circumflex (the arcuate artery) enters the proximal humerus at the superior end of the bicipital groove or by way of its branches into the adjacent greater and lesser tuberosities [1, 2]. Once the arcuate artery becomes intraosseous, it pursues a tortuous posteromedial course just below the epiphysis. Although a posterior circumflex artery branch can be the second supply, few anastomoses exist once the artery becomes intraosseous. The existence of only one principal artery and the tortuousness of the subchondral arterioles are the reasons for the vulnerability of the vascularity of the humeral head to impairment due to trauma and thromboembolic events. Traumatic ONHH can be seen after humeral neck fractures, shoulder dislocations, or surgery of the shoulder [3–5]. However, the majority of ONHH related to humeral neck fractures is quickly revascularized with creeping substitution without collapse, and the clinical impact of ONHH in fracture cases is relatively small compared to the fracture itself. Therefore, this chapter focuses on nontraumatic ONHH.

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Authors and Affiliations

  1. Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan

    Nobuhiko Sugano

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  1. Nobuhiko Sugano
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Correspondence to Nobuhiko Sugano .

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Editors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Kyonggi-do, Korea, Republic of (South Korea)

    Kyung-Hoi Koo

  2. Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, USA

    Michael A. Mont

  3. Department of Orthopaedic Surgery, Department of Orthopaedic Surgery, Center for Metabolism and Obesity Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Lynne C. Jones

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© 2014 Springer-Verlag Berlin Heidelberg

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Sugano, N. (2014). Osteonecrosis of the Humeral Head. In: Koo, KH., Mont, M., Jones, L. (eds) Osteonecrosis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35767-1_54

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  • DOI: https://doi.org/10.1007/978-3-642-35767-1_54

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