Humeral head avascular necrosis (AVN) can cause significant shoulder morbidity and represents the second most common site of nontraumatic osteonecrosis after the femoral head. The pathophysiology centers on disrupted blood supply, ultimately leading to bone death and structural compromise. It is associated with various etiologies, including trauma, iatrogenic factors, hematologic conditions, lifestyle factors, certain environmental exposures, and systemic diseases. Diagnosis relies on a combination of clinical assessment and radiographic evaluation, with magnetic resonance imaging serving as the most sensitive modality for early detection. The Cruess classification system guides treatment decisions. Although conservative measures are used in early stages, they carry a risk of progression, as they do not alter the disease course—unlike surgical techniques such as core decompression. Arthroplasty is reserved for later stages with evidence of collapse, with research suggesting that the use of pyrocarbon in hemiarthroplasty may help reduce glenoid erosion. This review provides a comprehensive overview of humeral head osteonecrosis, emphasizing its etiology, clinical evaluation, imaging findings, and treatment strategies. It highlights the growing support for early operative intervention over conservative management, emerging treatment modalities such as biologic augmentation and allografting, and promising new materials like pyrocarbon in hemiarthroplasty to mitigate glenoid erosion.

Midshaft clavicular fractures account for approximately 80% of all clavicle fractures in pediatric and adolescent populations and represent up to 15% of all fractures in adolescents. These injuries commonly result from falls, sports-related trauma, or motor vehicle accidents, with adolescent males experiencing fractures at rates up to three times higher than females. This review examines the diagnosis, classification, and management of these fractures, highlighting the nuances between pediatric and adult treatment approaches. Historically, nonoperative management has been favored, leveraging the adolescent clavicle’s remodeling capacity. Recent trends reflect increasing operative interventions, driven by adult studies demonstrating faster recovery and improved functional outcomes in displaced fractures. While nonoperative treatment, using slings or figure-of-8 braces, remains effective for most cases, operative fixation, including open reduction and internal fixation or elastic stable intramedullary nailing, is indicated for open fractures, neurovascular injury, or significant displacement. Studies demonstrate high union rates with both methods, but operative treatment offers quicker return to activity, albeit with higher risks of hardware- related complications. The Function after Adolescent Clavicle Trauma and Surgery study notably supports nonoperative management, showing similar long-term functional outcomes compared to operative treatment. Future research should focus on refining patient-reported outcome measures specific to adolescents and identifying subsets of patients who may benefit from surgery. Shared decision-making remains crucial for optimal patient-centered care.