Abstract
Neer's classification of proximal humeral fractures is widely accepted. However, fractures are encountered that are inconsistent with this system of classification. The objective of this study was to characterize such fractures, in which the fracture anatomy was observed during surgery.
Twenty shoulders of 19 patiants with displaced proximal humeral fractures or fracture-dislocations were studied. The subjects consisted of 7 males and 12 females; the age ranged from 17 to 85 years, an averaged was 64 years. The operative examination revealed: a 3-part fracture in 5 shoulders, a 4-part fracture in 4, a 3-part fracture-dislocation in 6 and 4-part fracture-dislocation in 5.
The operative findings of each case were compared with the preoperative roentgenograms and with Neer's classfication.
Five shoulders with a 3-part fracture were fractured in the greater tuberosity. Two displaced head patterns were found: 1)a valgus displacement in 3 cases,2)an internal rotation in 2 cases. Two causes of valgus dis placement were figured out. The first was the lesser tuberosity left to the shaft side, and the second was a head attached to the lesser tuberosity impacted to the shaft. Of the 4-part fractured shoulders, all the heads displaced into the valgus appear in Neer's classification. Five of the 3-part fracture-dislocation shoulders showed a fracture pattern which is not in Neer's classfication. In these cases, the greater and lesser tuberosi ties were not divided the one from the other but rather composed as a‘part’ which was displaced from the humeral head and from the shaft.
When we observe a proximal fracture, the fracture type should be determined by the head displacement pat tern rather than by the number of parts.
