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Classification of Proximal Humeral Frxs

- See:
        - Two Part Fractures
        - Three Part Fractures
        - Four Part Fracture

- Definition of Displaced:
    - segment displaced more than 10 mm or angulated more than 45 deg;

- Minimal Displacement:
    - results from low energy forces & has preserved soft tissue hinges;
    - pts w/ these frxs tend to have more pain than do pts w/ a impacted stable frx;
    - immobilization is required until sufficient fracture healing has taken place to render the patient pain free;

- Stable Frx (impacted vs non impacted);
   - definition:
         - a stable frx will not be displaced by physiological forces;
         - pt can actively move extremity wo pain, & limb can be moved passively w/ little pain & no abnormal motion between shaft & head fragment;
         - flouroscopy may indicate lack of independent motion between shaft & prox fragment;
   - rigidly impacted frx of the proximal humerus caused by low energy compressive forces fulfills these criteria, even if multiple fragments are present;
   - soft tissue hinges are most likely to be intact, so that AVN is unlikley
   - arm may be immobilized in a sling and early motion started immediately;
   - need for surgery is rare, except for stable frx w/ unacceptable displacement, for example, an impacted stable frx w/ excessive angulation in a young patient;
          - greater than 45 deg angulation will affect arm motion

The pattern of the fracture and displacement of the fragments predict the outcome in proximal humeral fractures

Classifications in Brief: The Neer Classification for Proximal Humerus Fractures