title: 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.
authors.affiliation: Department of Orthopaedics, Poriyya Government Hospital, Tiberias, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Edelson
authors.forename: I
authors.initials: I
authors.lastname: Kelly
authors.forename: F
authors.initials: F
authors.lastname: Vigder
authors.forename: N D
authors.initials: ND
authors.lastname: Reis
mesh_terms: D002102:Cadaver; D006801:Humans; D006810:Humeral Fractures / Q000145:classification* / Q000000981:diagnostic imaging / Q000209:etiology; D015203:Reproducibility of Results; D014056:Tomography, X-Ray / Q000379:methods