[Contribution to the problem of classification of fractures of the proximal end of the humerus in adults.].
A classification is useful only if it helps the surgeon to resolve a given fracture. This applies obviously also to fractures of the proximal end of the humerus. In the submitted paper the authors review the problem of classification of fractures of the proximal humerus which could help orthopaedists and traumatologists to decide on the therapeutic approach to these serious injuries. For a long time it did not prove possible to elaborate a classification which meets contemporary theoretical demands and practical needs. Some hitherto used older classifications are based on the course of the fracture line or the mechanism of the injury; they do not assess accurately the types of fractures and are not an effective guideline for treatment. The authors mention, or at least remind of all important attempts of various authors to classify fractures of the proximal end of the humerus. Some of these attempts are historically important (Malgaigne, Kocher, Böhler, Codman, Watson-Jones, Dehne, Typovský, Duparc and Largier). Codman's basic four-fragment classification has become the basis of subsequent more modern classifications which are used at present and which are analyzed in more detail by the authors. This applies to the classifications by Neer, AO, Tile and to Habermeyer's classification. In the discussion their advantages and shortcomings are considered. From the literature it is obvious that Neer's classification is the most widely used one. For the correct enlistment of a fracture into a certain classification pattern it is essential to assess accurately the fracture line between fragments of the fracture. Among commonly available imaging methods Neer's "traumatic series" of three X-ray pictures or an oblique "apical" projection recommended by Richardson et al. is considered most reliable. The most up-to-date imaging methods such NMR, CT and 3D-CT are, no doubt, more instructive but for the given purpose they are too expensive and so far not readily available in this country. The authors conclude that for a problem so varied as fractures of the proximal humerus it is very difficult to find a uniform classification, which will meet all demands (i.e. logical structure, overview, simple procedure, while at the same time complete, reproducible and offering the possibility of prognosis and assessment of the therapeutic procedures). All classifications have in some of the required criteria greater or smaller shortcomings. The mentioned modern classifications meet to a certain extent their purpose and each department which is used to a method will find it difficult to switch over to another one. Because all classifications comprise also therapeutic guidelines for treatment of different types of fractures, the therapeutic results achieved by the given department in the treatment of fractures of the proximal humerus by using a certain classification are decisive. Key words: classification of fractures of the proximal humerus.
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Ortopedická klinika 1. lékarské fakulty KU, Praha.
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