Proximal Humerus Fractures
CLASSIFICATION
Codman(1934) first described the 4 main fracture fragments (segments) & their attachments, which cause displacement:
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Greater tuberosity - supraspinatus, infraspinatus & teres minor
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Lesser tuberosity - subscapularis
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Head
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Shaft - pec major (displaces shaft medially & internal rotation)
Neer Classification
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first described in 1970, then simplified in 1975.
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Developed from the retrospective review of 300 fractures.
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Requirements to classify fractures:
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Adequate radiographs (= Trauma series +/- CT scans)
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Knowledge of the pathology & deforming forces
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Segment Angulation of 45deg.
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Segment Displacement of 1cm
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Reliability of Neer classification:
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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.
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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.
- Siebenrock KA, Gerber C. J Bone Joint Surg Am. 1993 Dec;75(12):1751-5.
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INVESTIGATIONS
Trauma Series Radiographs:
Must have all three films to classify according to Neer (can use CT scans as well)
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