Fractures of the Proximal Humerus

Proximal humerus fractures are common injuries, particularly among the elderly. They can range from simple non-displaced fractures to complex multi-fragmentary fractures.

Classification of Proximal Humerus Fractures

Neer Classification

The Neer classification system divides fractures based on the number of displaced parts:

• One-part fracture: Minimal displacement, often treated conservatively.
• Two-part fracture: Displacement of either the surgical neck or greater tuberosity.
• Three-part fracture: Involves displacement of both the greater tuberosity and surgical neck.
• Four-part fracture: Severe fragmentation with head dislocation; often requires surgery.

AO/OTA Classification

The AO/OTA system provides a more detailed classification, categorizing fractures based on location and complexity:

• Type A: Extra-articular, simple
• Type B: Extra-articular, multi-fragmentary
• Type C: Articular involvement

Management and Treatment

Treatment depends on fracture type and patient condition:

• Non-surgical: Sling immobilization, physiotherapy for early mobilization.
• Surgical: Open reduction and internal fixation (ORIF), hemiarthroplasty, or total shoulder arthroplasty for severe cases.