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Classification of Proximal Humeral Fractures

- See:
- Two Part Fractures
- Three Part Fractures
- Four Part Fracture

- Definition of Displaced:
- segment displaced more than 10 mm or angulated more than 45 deg;

- Minimal Displacement:
- results from low energy forces & has preserved soft tissue hinges;
- pts w/ these frxs tend to have more pain than do pts w/ a impacted stable frx;
- immobilization is required until sufficient fracture healing has taken place to render the patient pain free;

- Stable Frx (impacted vs non impacted);
- definition:
- a stable frx will not be displaced by physiological forces;
- pt can actively move extremity wo pain, & limb can be moved passively w/ little pain & no abnormal motion between shaft & head fragment;
- flouroscopy may indicate lack of independent motion between shaft & prox fragment;
- rigidly impacted frx of the proximal humerus caused by low energy compressive forces fulfills these criteria, even if multiple fragments are present;
- soft tissue hinges are most likely to be intact, so that AVN is unlikley
- arm may be immobilized in a sling and early motion started immediately;
- need for surgery is rare, except for stable frx w/ unacceptable displacement, for example, an impacted stable frx w/ excessive angulation in a young patient;
- greater than 45 deg angulation will affect arm motion

The pattern of the fracture and displacement of the fragments predict the outcome in proximal humeral fractures

Classifications in Brief: The Neer Classification for Proximal Humerus Fractures