A three-dimensional classification for fractures of the proximal humerus

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.

Proximal humerus fractures

“…The AO classification seems to have the same problems as the Neer classification (Siebenrock and Gerber, 1993). Interestingly, recent efforts to develop new classifications have identified fracture patterns similar to those recognized by Codman and Neer as well as other patterns not previously described (Edelson et al, 2004). These papers have helped to recognize that the fracture lines are not very common at the bicipital groove itself, but at lateral, or lateral and medial, to the groove, delineating a fifth segment that some authors have compared to the shape of a shield (Edelson et al, 2004) and contains the groove as well as part of the greater and lesser tuberosity.…”

Hackethal Bundle Nailing with Intramedullary Elastic Nails in the Treatment of Two- and Three-Part Fractures of the Proximal Humerus: Initial Experience at Al Razi Hospital, Kuwait

“…CT scans with 3D reconstruction ( fig. 1 ) enabled us to classify fractures according to the classification proposed by Edelson et al [14] . The fracture was reduced by traction and manipulation with a Schanz screw (joystick technique) and monitored using an image intensifier.…”

Proximal humeral fractures

“…14 Since 2003, new systems of fracture classifications have been published. 20,22,31,32 Hertel 22 presented a structured system for reading images, including 12 questions, which require 3-D image measurements. Fractures were classified using a binary description system combining the four fragments and the five basic planes of the fracture.…”