Neer classification
Fracture of proximal humerus1
Anatomy of proximal humerus
Learn the epidemiology of proximal humeral fractureMechanism of injury and clinical feature
Understands the fracture patterns with majour emphasis on neer classification
Learn various treatment options
Majour complication
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objectives
Anatomy of the humerus
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5% of all fracture
Higher incidence in elderlyFemale 2:1 greater incidence than male
85% are minimally or non displaced & generally treated non operative
MECHANISM OF INJURY
Low energy (most common)
Fall from a standing height
Outstretched arm
• Elderly osteoprotic
• High energy (young )
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epidemiology
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mechanism
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Clinical feature
Two main components
Number of fracture partdisplacement
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Main components off classification
One _part fracture
Fracture lines involve 1-4partsNon of the parts are displaced (<1cm&<45degree)
70_80% of all proximal humeral fracture
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Classification
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X RAY
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3D CT
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MRI
Conservative
12Treatment type one
Two part fracture
20% of proximal humeral fractureFracture lines involve 2-4 parts
One part is displaced(>1cm&>45degree)
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Types of two part fracture
Anatomical neckSurgical neck (most common)
Greater tuberosity
Lesser tuberosity
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X RAY
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X RAY
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X RAY
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X RAY
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CT
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3D CT
• Close reduction (MUA&sling ) 6weeks and active exercise later if failure
• Open reduction & internal fixation by percutaneous pinning plate and screws or intramedullary nailing21
TREATMENT
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Plate and screws
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Plate AND SCREWS
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Three part fracture
Its account for 5%of proximal
Humeral fracture
Fracture line involve 3_4 part
Two part are displaced more than
1cm
Or more than 45 degrees
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X RAY
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X RAY
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CT
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TREATMENT
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ORIF
UNCOOMMON LESS THAN 1%
Three parts are displacedMore than 1cm
Or more than 45degrees
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FOUR PART FRACTURE
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X RAY
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CT
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TRATMENT IN YOUNG
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ARTHROPLASTY
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1-VASCULAR INJURY
38COMPLICATION
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2-STIFFNESS OF SHOULDER
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3-MALUNION
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4_AVASCULAR NECROSIS
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