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Proximal Humerus Fractures


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)

Proximal Humerus Segments & deforming forces

Neer ClassificationNeer 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. 




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)

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