The Neer four-segment classification is accepted as a standard tool for management of proximal humeral fractures. Some fractures, however, do not come under any type in this classification. We reviewed 67 fractures in 66 patients who underwent open surgery for proximal humeral fractures. There were 14 two-part,27 threepart,18 four-part,7 valgus-impacted, and 1 head-splitting fractures. The surgical anatomy of these fractures was divided into 14 possible patterns described by Codman. Excluding valgus-impacted and head-splitting fractures,17 (29%) of the 59 fractures did not come under any category of the Neer classification. These were: (1) 1 two-part fracture (HH [humeral head] + LT [lesser tuberosity] / GT [greater tuberosity] + shaft); (2) 1 twopart fracture (HH + shaft / GT + LT); (3) 2 three-part fractures (HH / LT + shaft / GT); and (4) 13 three-part fractures (HH / GT + LT / shaft). We concluded that fractures that are not described in the Neer classification are not rare, and that the accurate anatomy should be recognized to assess the circulatory status of the humeral head and to choose appropriate treatment.
