MECANISM AND CLASSIFICATIONS OF ESH FRACTURES

1. SERVICE ORTHOPEDIE A
PR BENHABILES
PRESENTED BY
DR AGGOUN
ANAPATH OF
PROXIMAL
HUMERUS
FRACTURES

2. PLAN
INTRODUCTION
DIAGNOSTIC
MECHANISM
CLASSIFICATIONS
CHOOSING THE CLASSIFICATION
TREATEMENT
CONCLUSION

3. INTRODUCTION
Proximal humerus fractures are
common injuries, especially in older
adults. They can occur as a result of
falls, motor vehicle accidents, and
other types of trauma.
Understanding the different
classifications of these fractures is
important for choosing the best

4. DIAGNOSTIC
History: the mechanism of
injury, symptoms, and
medical history.
Physical examination:
Severe pain in the shoulder
, Swelling and bruising of
the shoulder , Deformity of
the shoulder , Inability to
move the arm ;Numbness
or tingling in the arm

5. DIAGNOSTIC
Imaging tests:
X-rays: the most
important imaging test
for diagnosing proximal
humerus fractures
CT scan: if we needs
more information about
the fracture.
MRI scan: used to assess

6. ANAPATH
MECHANISM
CLASSIFICATIONS

7. MECHANISM
Direct or Indirect
low-energy falls
elderly with osteoporotic bone
high-energy trauma(direct trauma)
young individuals
concomitant soft tissue and neurovascular
injuries

8. CLASSIFICATIONS
EARLY
CLASSIFICATIONS:
•Codman (1934)
•Neer (1970)
MODERN
CLASSIFICATIONS:
•AO/OTA (1980s )
•Codman-Hertel
(2004):
•Resch (2016)
•MAYO FJD (2020)

9. CODMAN
Based on four anatomic
parts (humeral shaft,
articular surface,
greater tuberosity, and
lesser tuberosity) but
did not consider
displacement.

10. NEER
The most commonly used
classification
 The basis of the system
according to
1.Displacement
2.Anatomical lines of
epiphyseal union

11. NEER
considered a separate part if
displacement of > 1 cm
45° angulation

12. MODIFIED NEER
CLASSIFICATION
Group I: Minimally displaced fractures (one-part and
some two-part fractures)
Group II: Displaced anatomic neck fractures
Group III: Displaced surgical neck fractures
Group IV: Displaced greater tuberosity fractures
Group V: Displaced lesser tuberosity fractures
Group VI: Fracture-dislocation

13. ADVANTAGES
Has ability to separate PHF into broad
categories, which are intuitively understood and
which have important differences.
widely used by surgeons because, at least
broadly speaking, it has been found useful to
guide treatment, anticipate prognosis, and
group similar fracture patterns for research
purposes.
The classification system also is pedagogically
useful for orthopaedic trainees in that it helps
explain how the deforming forces around the

14. LIMITATIONS
including limited ability to distinguish
among the many patterns of one-part
fractures
 does not incorporate several variables
such as the length of the metaphyseal
hinge, magnitude of initial displacement,
and varus displacement that predict
clinical outcome scores.

15. AO/OTA
Based on articular
surface involvement,
anatomic location, and
dislocation. Divides
fractures into three
main types with further
subdivisions. Identifies
valgus impaction of the
proximal humeral neck.
Complete and complex

16. CODMAN-HERTEL
Binary system based
on fracture
morphology and
predictors of fracture-
induced humeral head
ischemia. Uses
structured
questionnaires to

17. RESCH
Similar
scheme
focusing on
valgus vs varus
impacted
fractures.

18. MAYO FJD
It is a newer
system that has
been shown to be
reliable and easy
to use. It divides
proximal humerus
fractures into
seven main types
based on the

19. CHOOSING THE CLASSIFICATION
Choosing the right classification system depends on
the patient's age, medical history, and the severity
of the fracture.
that Codman-Hertel had the highest reliability,
followed by Neer, then Resch, and finally AO/OTA
The Neer classification is a good choice for simple,
undisplaced fractures. The AO/OTA classification is
a good choice for more complex fractures.
The Mayo-FJD classification may be a good choice
for all types of proximal humerus fractures.

20. THE TREATMENT
The treatment of proximal
humerus fractures depends on
the specific classification of the
fracture. Non-surgical
treatment may be an option for
some fractures, such as
undisplaced 1-part fractures.
However, most proximal
humerus fractures require
surgery.
variety of surgical techniques
that can be used The most

21. CONCLUSION
Proximal humerus fractures are a common injury
that can be caused by a variety of factors.
There are several different ways to classify these
fractures
Other classifications: Habermeyer and
Schweiberer ,and Gerber
Despite its limitation neer is still the most used
one

22. REFERENCES
•Management of Proximal Humerus Fractures in Adults—A Scoping Review
Hayden P. Baker,* Joseph Gutbrod, Jason A. Strelzow, Nicholas H. Maassen,
and Lewis Shi* Alexandre Lädermann, Academic Editor and J. Christoph
Katthagen, Academic Editor
•Classification of proximal humerus fractures according to pattern
recognition is associated with high intraobserver and interobserver
agreement panelAntonio M. Foruria MD, PhD a, Natalia Martinez-Catalan MD
a, Belen Pardos MD a, Dirk Larson MS b, Jonathan Barlow MD, MS c, Joaquín
Sanchez-Sotelo MD, PhD 2022
•imaging to improve agreement for proximal humeral fracture classification
in adult patient: a systematic review of quantitative studies J Clin
orthopaedics Trauma, 11 (2020), pp. S16-S24, 10.1016/j.jcot.2019.06.019
•Kilcoyne, R. F., et al. (1990). “The Neer classification of displaced proximal
humeral fractures: spectrum of findings on plain radiographs and CT scans.
•https://radiopaedia.org/articles/neer-classification-of-proximal-humeral-

23. THANK