Proximal Humeral Fractures

Background

• Accounts for 4-5% of all fractures
• Often missed when co-existing with multiple injuries
• Fractures in young people - violent trauma
• Fractures in elderly people - minor trauma
• Can occur in both children and adults

Classification

Neer's classification

• Group 1 – All fractures with minimal displacement and minimal angulation (displacement  <1cm, angulation < 45 degrees)
• Group 2 – Fractures through the anatomical neck with displacement >1cm. Can be complicated by AVN of the humeral head
• Group 3 – Fractures of the surgical neck with significant displacement and / or severely angulated fragments. Can be complicated by axillary nerve damage
• Group 4 – Fractures of the greater tuberosity displaced by the pull of the supraspinatus tendon. Can be complicated by impingement syndrome
• Group 5 – Fractures of the lesser tuberosity
• Group 6 – Fracture-dislocations