Proximal Humerus Fractures

CLASSIFICATION

Codman(1934) first described the 4 main fracture fragments (segments) & their attachments, which cause displacement:

1. Greater tuberosity - supraspinatus, infraspinatus & teres minor

2. Lesser tuberosity - subscapularis

3. Head

4. Shaft - pec major (displaces shaft medially & internal rotation)

Neer Classification

• first described in 1970, then simplified in 1975.

• Developed from the retrospective review of 300 fractures.

• Requirements to classify fractures:

  • Adequate radiographs (= Trauma series +/- CT scans)

  • Knowledge of the pathology & deforming forces

  • Segment Angulation of 45deg.

  • Segment Displacement of 1cm

• Reliability of Neer classification:

  • 3 studies have shown poor inter & intraobserver reliability:

  1. Kristiansen B, Andersen UL, Olsen CA, Varmarken JE.  Skeletal Radiol. 1988;17(6):420-2. - did not use full trauma series; used a condensed Neer classification; intra-observer reliability was not assessed.

  2. Sidor ML, Zuckerman JD, Lyon T, Koval K, Cuomo F, Schoenberg N. J Bone Joint Surg Am. 1993 Dec;75(12):1745-50. - demonstrated that experience improves reliability.

  3. Siebenrock KA, Gerber C. J Bone Joint Surg Am. 1993 Dec;75(12):1751-5. 

INVESTIGATIONS

Trauma Series Radiographs:

Anteroposterior view - in plane of scapula	Lateral view - in plane of scapula	Velpeau modified axillary view

Must have all three films to classify according to Neer (can use CT scans as well)