Fracture of proximal humerus - Neer classification system of proximal humeral fractures
Neer's classification of proximal humerus fracture considers four major parts of the proximal humerus:
- humeral head with articular surface
- greater tubercle
- lesser tubercle
- diaphysis.
In the childhood, the four parts are separated by growth plates. A fragment is considered separate, when it is displaced by at least 1cm or angulated by 45 and more degrees. The basic division of fractures is based on the number of fragments: undisplaced (1-part), 2-part, 3-part, and 4-part fractures.
| Type | Subtype | |
|---|---|---|
| I | Minimal displacement | 1-part |
| II | Anatomical neck | 2-part |
| III | Surgical neck | 2-part |
| IV | Greater tuberosity | 2, 3, or 4-part |
| V | Lesser tuberosity | 2, 3, or 4-part |
| VI | Fracture dislocation | - anterior - 2, 3, 4-part, or articular surface involvement - posterior - 2, 3, 4-part, or articular surface involvement |
References:
1. Neer CS. Displaced Proximal Humeral Fractures PART I. Classification and evaluation. J Bone Joint Surg Am. 1970 Sep 1;52(6):1077–89
2. Widnall JC, Dheerendra SK, Malal JJG, Waseem M. Proximal Humeral Fractures: A Review of Current Concepts. Open Orthop J. 2013 Sep 6;7:361–5
3. Pope TL, Jr JHH. Harris & Harris’ Radiology of Emergency Medicine. Lippincott Williams & Wilkins; 2012:334.