The three-dimensional anatomy of proximal humeral fractures

Hypothesis

Three-dimensional (3D) computed tomography (CT) reconstructions have the potential to convey the anatomy of proximal humeral fractures more realistically than do standard 2D images.

Material and methods

Proximal humeral fractures in 248 adult patients were examined prospectively using 3D CT reconstructions. To our knowledge, this represents the largest reported series of such fractures examined by this method.

Results

Of 248 fractures examined by a 3D classification system, 14% were of the 2 Part type, 36% were 3 Part, 21% were Shield fractures, 13% were isolated tuberosity injuries, and 16% were fracture dislocations.

Conclusions

This study led to a modification of the Neer classification system. The frequency of each type of injury in this new classification is presented and a technique for viewing 3D images is suggested which maximizes their usefulness.

Level of evidence

Level 2; Clinical, observational, and prospective.

Keywords: Proximal humeral fracture, 3D classification of proximal humeral fracture