Barw Barw Medical Journal 2960-1959 3 2 2025 03 05 Asymptomatic Osteonecrosis of the Trochlea in an Adolescent: A Case Report 10.58742/bmj.v3i2.158 eng Abdullah K. Ghafour Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. abdullah.ghafour@gmail.com Soran S. Raoof Smart Health Tower (Raparin Branch), Karux Street, Rania, Iraq. soran.raoof@gmail.com Soran H. Tahir College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. soran.tahir@uniivsul.edu.iq Rezheen J. Rashid Radiology Department, Hiwa Hospital, Sulaymaniyah, Iraq. rezheen.rashid@gmail.com Dyari Q. Hamad Smart Health Tower (Raparin Branch), Karux Street, Rania, Iraq. dyari.hamad@gmail.com Pshdar H. Ramadhan Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. pshdar12@gmail.com Hawkar A. Nasralla Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. hawkar.arf96@gmail.com Karukh K. Mohammed Kscien Organization for Scientific Research (Middle East Office), Hamid Street, Azadi Mall, Sulaymaniyah, Iraq. karukh.mohammed@gmail.com Bootan J. Raheem Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. bootan.raheem@gmail.com 2025 02 02 Introduction Osteonecrosis, also known as avascular necrosis, aseptic necrosis, or ischemic necrosis, results from a temporary or permanent halt in blood flow to a portion of bone. This lack of blood supply can eventually cause the affected bone to collapse. Osteonecrosis around the elbow is not frequently observed. However, its occurrence in the trochlea known as Hegemann's disease is even rarer. Incidence rates of trochlear osteonecrosis have been reported to vary from 0.27% to less than 0.001% across different studies. Case presentation A 14-year-old male presented with severe right shoulder pain and swelling, along with mild right lateral-sided elbow pain due to a fall to the ground. The radiograph of the right shoulder revealed a proximal humeral metaphyseal greenstick fracture. Additionally, the radiograph of the right elbow incidentally revealed osteonecrosis of the distal humeral trochlea. The affected shoulder was immobilized and Conservative management was selected for treating the trochlear osteonecrosis. Conclusion Trochlear avascular necrosis is a rare condition that might cause mild discomfort or even be asymptomatic, potentially being diagnosed incidentally through radiographs. Typically, it can be managed with conservative treatment methods.