No abstract

Existing classifications of fractures of the head of the humerus are inadequate in terms of interobserver reliability and the predictability of the clinical outcome. From a combined study of 73 fracture specimens in museums and 84 CT-three-dimensional reconstructions in patients, we have devised a classification which appears to be more useful clinically. Common patterns of fracture and a plausible mechanism of injury were observed. In 3-D most proximal humeral fractures can be organised into five basic types. These correspond in some degree to the Codman/Neer classification, but differ significantly in regard to the more complex patterns of fracture. We observed a logical progression from simple to complex fractures. An interobserver reliability study was carried out which indicated the improved usefulness of this new 3-D concept in providing a common language among clinicians for classifying these injuries. When surgery is indicated, the 3-D concept is also invaluable in guiding the restitution of anatomy through either open or percutaneous means.

No abstract

The authors present a series of seven juxtaepiphyseal fractures at the base of the distal phalanx of the finger. Prior to closure of the epiphysis, the fracture line is usually through the growth plate (Salter-Harris type I or II) or 1 to 2 mm distal to the plate. Clinically the injury looks like a mallet finger, but the pathoanatomy is not that of the classic mallet. All seven of these fractures were treated by closed reduction, six fractures were fixed by a Kirschner wire, and one was held by splinting only. All healed without complications.