title: Multifocal humeral fractures.
abstract: BACKGROUND
  Multifocal humeral fractures are extremely rare. These may affect the neck and the shaft, the shaft alone, or the diaphysis and the distal humerus. There is no classification of these fractures in the literature.
  
  
  METHODS
  From 2004 to 2010, 717 patients with humeral fracture were treated surgically at our department. Thirty-five patients presented with an associated fracture of the proximal and diaphyseal humerus: synthesis was performed with plate and screws in 34 patients, and the remaining patient had an open fracture that was treated with an external fixator.
  
  
  RESULTS
  Mean follow-up was 3 years and 3 months. A classification is proposed in which type A fractures are those affecting the proximal and the humeral shaft, type B the diaphysis alone, and type C the diaphysis in association with the distal humerus. Type A fractures are then divided into three subgroups: A-I, undisplaced fracture of the proximal humerus and displaced shaft fracture; A-II: displaced fracture of the proximal and humeral shaft; and A-III: multifragmentary fracture affecting the proximal humerus and extending to the diaphysis.
  
  
  CONCLUSIONS
  Multifocal humeral fractures are very rare and little described in the literature, both for classification and treatment. The AO classification describes bifocal fracture of the humeral diaphysis, type B and C. The classification suggested in this article mainly concerns fractures involving the proximal and humeral shaft.
  
  
  CONCLUSIONS
  A simple classification of multifocal fractures is suggested to help the surgeon choose the most suitable type of synthesis for surgical treatment.
authors.affiliation: Unità di Ortopedia e Traumatologia Ospedali Riuniti di Ancona, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Maresca
authors.affiliation: Unità di Ortopedia e Traumatologia Ospedali Riuniti di Ancona, Italy. Electronic address: raffaele.pascarella@libero.it.
authors.forename: R
authors.initials: R
authors.lastname: Pascarella
authors.affiliation: Unità di Ortopedia e Traumatologia Ospedale Maggiore Bologna, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Bettuzzi
authors.affiliation: Unità di Ortopedia e Traumatologia Ospedale Maggiore Bologna, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Amendola
authors.affiliation: Unità di Ortopedia e Traumatologia Ospedali Riuniti di Ancona, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Politano
authors.affiliation: Unità di Ortopedia e Traumatologia Ospedali Riuniti di Ancona, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Fantasia
authors.affiliation: Unità di Ortopedia e Traumatologia Ospedali Riuniti di Ancona, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Del Torto
mesh_terms: D001860:Bone Plates; D018483:Diaphyses / Q000503:physiopathology / Q000601:surgery*; D004867:Equipment Design; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000145:classification / Q000503:physiopathology / Q000601:surgery*; D006811:Humerus / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D017410:Practice Guidelines as Topic; D011826:Radial Nerve / Q000293:injuries*; D020425:Radial Neuropathy / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function
keywords: Bifocal; Classification; Humeral fractures; Multifocal