Babhulkar and Babhulkar developed a staging system for osteonecrosis of the humeral head. This was developed for patients with sickle cell hemoglobinopathy. The authors are from the Medical College Sushrut Hospital and Jawaharlal Nehru Medical College in India.
Parameters on imaging studies:
(1) densities
(2) bony changes (separation, fragmentation and/or collapse)
(3) articular changes
Densities |
Bony Changes |
Articular Changes |
Stage |
none |
none |
none |
0 |
spotty in subchondral region with irregularities |
none |
none |
I |
rim-like area in juxta-articular portion; may have larger densities |
no chondro-osseous separation |
none |
II |
increased density |
obvious cleavage (chondro-osseous separation) with crescent sign |
none |
III |
increased density |
fragmentation without change in contour of the femoral head |
none |
IV |
NA |
mild collapse |
mild irregularities |
V |
NA |
moderate to severe collapse |
hypertrophic changes |
VI |
Specialty: Surgery, orthopedic