Proximal humeral fracture

Q: How would you describe this fracture? show answer

A: This is a minimally displaced fracture involving the surgical neck of humerus and greater tuberosity.

Q: What classification system is most frequently used for proximal humeral fractures? show answer

A: The Neer classification, described in 1970.

Q: According to the Neer classification, how many parts is the proximal humerus divided into? What are they? show answer

A: Four parts: humeral head bearing the articular surface; greater tuberosity; lesser tuberosity; humeral shaft. Fractures separating the articular surface of the humeral head from the rest of the proximal humerus are termed anatomical neck fractures. Fractures separating the shaft from the humeral head and the tuberosities are termed surgical neck fractures.

Q: In the Neer classification, would this be a one, two, three or four part fracture? Why? show answer

A: A little counterintuitively this would be considered a one-part fracture, as although both a greater tuberosity and surgical neck of humerus fracture are present neither are significantly displaced (<1 cm) nor are they significantly angulated (<45 degrees).

Q: What proportion of all proximal humeral fractures are one-part (minimally displaced) according to the Neer classification? show answer

A: Approximately 75%.

Q: How are un-displaced / minimally displaced (one part fractures) usually treated? show answer

A: Conservative management, with sling usually suffices and results in acceptable functionality.