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Erschienen in: Clinical Orthopaedics and Related Research® 1/2013

01.01.2013 | In Brief

Classifications in Brief: The Neer Classification for Proximal Humerus Fractures

verfasst von: Bradley C. Carofino, MD, Seth S. Leopold, MD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 1/2013

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Excerpt

Proximal humerus fractures are the third most common fracture type in individuals older than 65 years, after distal radius and proximal femur fractures [8]. In 1970, Charles Neer described his four-segment classification system [18]. He believed the existing classifications were inadequate for research purposes, as they did not differentiate between injuries of varied severity nor did they group like fractures [5, 12, 18]. The classification systems at that time were based on the mechanism of injury or level of the fracture line, but did not consider many surgically important aspects or pathologic features of injury such as tuberosity displacement [18]. Forty years later, surgeons continue to use Neer’s four-segment fracture classification system for proximal humerus fractures because it is useful in guiding treatment, grouping similar fracture patterns for research purposes, and explaining pathologic features of injury. …
Literatur
1.
Zurück zum Zitat Andersen E, Jorgensen LG, Hededam LT. Evans’ classification of trochanteric fractures: an assessment of the interobserver and intraobserver reliability. Injury. 1990;21:377–378.PubMedCrossRef Andersen E, Jorgensen LG, Hededam LT. Evans’ classification of trochanteric fractures: an assessment of the interobserver and intraobserver reliability. Injury. 1990;21:377–378.PubMedCrossRef
2.
Zurück zum Zitat Bahrs C, Rolauffs B, Dietz K, Eingartner C, Weise K. Clinical and radiological evaluation of minimally displaced proximal humeral fractures. Arch Orthop Trauma Surg. 2010;130:673–679.PubMedCrossRef Bahrs C, Rolauffs B, Dietz K, Eingartner C, Weise K. Clinical and radiological evaluation of minimally displaced proximal humeral fractures. Arch Orthop Trauma Surg. 2010;130:673–679.PubMedCrossRef
3.
Zurück zum Zitat Bastian JD, Hertel R. Initial post-fracture humeral head ischemia does not predict development of necrosis. J Shoulder Elbow Surg. 2008;17:2–8.PubMedCrossRef Bastian JD, Hertel R. Initial post-fracture humeral head ischemia does not predict development of necrosis. J Shoulder Elbow Surg. 2008;17:2–8.PubMedCrossRef
4.
Zurück zum Zitat Bernstein J, Adler LM, Blank JE, Dalsey RM, Williams GR, Iannotti JP. Evaluation of the Neer system of classification of proximal humeral fractures with computerized tomographic scans and plain radiographs. J Bone Joint Surg Am. 1996;78:1371–1375.PubMed Bernstein J, Adler LM, Blank JE, Dalsey RM, Williams GR, Iannotti JP. Evaluation of the Neer system of classification of proximal humeral fractures with computerized tomographic scans and plain radiographs. J Bone Joint Surg Am. 1996;78:1371–1375.PubMed
5.
Zurück zum Zitat Bohler L. The Treatment of Fractures. 5th ed. New York, NY: Grune and Stratton; 1956. Bohler L. The Treatment of Fractures. 5th ed. New York, NY: Grune and Stratton; 1956.
6.
Zurück zum Zitat Brunner A, Honigmann P, Treumann T, Babst R. The impact of stereo-visualisation of three-dimensional CT datasets on the inter- and intraobserver reliability of the AO/OTA and Neer classifications in the assessment of fractures of the proximal humerus. J Bone Joint Surg Br. 2009;91:766–771.PubMedCrossRef Brunner A, Honigmann P, Treumann T, Babst R. The impact of stereo-visualisation of three-dimensional CT datasets on the inter- and intraobserver reliability of the AO/OTA and Neer classifications in the assessment of fractures of the proximal humerus. J Bone Joint Surg Br. 2009;91:766–771.PubMedCrossRef
7.
Zurück zum Zitat Codman EA. The Shoulder Rupture of the Supraspinatus Tendon and Other Lesion in or About the Subacromial Bursa. Boston, MA: Thomas Todd Co; 1934. Codman EA. The Shoulder Rupture of the Supraspinatus Tendon and Other Lesion in or About the Subacromial Bursa. Boston, MA: Thomas Todd Co; 1934.
8.
Zurück zum Zitat Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37:691–697.PubMedCrossRef Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37:691–697.PubMedCrossRef
9.
Zurück zum Zitat Dias JJ, Taylor M, Thompson J, Brenkel IJ, Gregg PJ. Radiographic signs of union of scaphoid fractures: an analysis of inter-observer agreement and reproducibility. J Bone Joint Surg Br. 1988;70:299–301.PubMed Dias JJ, Taylor M, Thompson J, Brenkel IJ, Gregg PJ. Radiographic signs of union of scaphoid fractures: an analysis of inter-observer agreement and reproducibility. J Bone Joint Surg Br. 1988;70:299–301.PubMed
10.
Zurück zum Zitat Helwig P, Bahrs C, Epple B, Oehm J, Eingartner C, Weise K. Does fixed-angle plate osteosynthesis solve the problems of a fractured proximal humerus? A prospective series of 87 patients. Acta Orthop. 2009;80:92–96.PubMedCrossRef Helwig P, Bahrs C, Epple B, Oehm J, Eingartner C, Weise K. Does fixed-angle plate osteosynthesis solve the problems of a fractured proximal humerus? A prospective series of 87 patients. Acta Orthop. 2009;80:92–96.PubMedCrossRef
11.
Zurück zum Zitat Hertel R, Hempfing A, Stiehler M, Leunig M. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg. 2004;13:427–433.PubMedCrossRef Hertel R, Hempfing A, Stiehler M, Leunig M. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg. 2004;13:427–433.PubMedCrossRef
12.
Zurück zum Zitat Kocher T. Beitrage zur Kenntniss einiger praktisch wichtiger Fracturenformen. Basel, Switzerland: Carl Sollman; 1896. Kocher T. Beitrage zur Kenntniss einiger praktisch wichtiger Fracturenformen. Basel, Switzerland: Carl Sollman; 1896.
13.
Zurück zum Zitat Koval KJ, Gallagher MA, Marsicano JG, Cuomo F, McShinawy A, Zuckerman JD. Functional outcome after minimally displaced fractures of the proximal part of the humerus. J Bone Joint Surg Am. 1997;79:203–207.PubMed Koval KJ, Gallagher MA, Marsicano JG, Cuomo F, McShinawy A, Zuckerman JD. Functional outcome after minimally displaced fractures of the proximal part of the humerus. J Bone Joint Surg Am. 1997;79:203–207.PubMed
14.
Zurück zum Zitat Kristiansen B, Andersen UL, Olsen CA, Varmarken JE. The Neer classification of fractures of the proximal humerus: an assessment of interobserver variation. Skeletal Radiol. 1988;17:420–422.PubMedCrossRef Kristiansen B, Andersen UL, Olsen CA, Varmarken JE. The Neer classification of fractures of the proximal humerus: an assessment of interobserver variation. Skeletal Radiol. 1988;17:420–422.PubMedCrossRef
15.
Zurück zum Zitat Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics. 1977;33:363–374.PubMedCrossRef Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics. 1977;33:363–374.PubMedCrossRef
16.
Zurück zum Zitat Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174.PubMedCrossRef Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174.PubMedCrossRef
17.
Zurück zum Zitat Majed A, Macleod I, Bull AM, Zyto K, Resch H, Hertel R, Reilly P, Emery RJ. Proximal humeral fracture classification systems revisited. J Shoulder Elbow Surg. 2011; 20:1125–1132.PubMedCrossRef Majed A, Macleod I, Bull AM, Zyto K, Resch H, Hertel R, Reilly P, Emery RJ. Proximal humeral fracture classification systems revisited. J Shoulder Elbow Surg. 2011; 20:1125–1132.PubMedCrossRef
18.
Zurück zum Zitat Neer CS 2nd. Displaced proximal humeral fractures: I. Classification and evaluation. J Bone Joint Surg Am. 1970;52:1077–1089.PubMed Neer CS 2nd. Displaced proximal humeral fractures: I. Classification and evaluation. J Bone Joint Surg Am. 1970;52:1077–1089.PubMed
19.
Zurück zum Zitat Neer CS 2nd. Displaced proximal humeral fractures: Part I. Classification and evaluation. By Charles S. Neer, I, 1970. Clin Orthop Relat Res. 1987;223:3–10.PubMed Neer CS 2nd. Displaced proximal humeral fractures: Part I. Classification and evaluation. By Charles S. Neer, I, 1970. Clin Orthop Relat Res. 1987;223:3–10.PubMed
20.
Zurück zum Zitat Neer CS 2nd. Four-segment classification of proximal humeral fractures: purpose and reliable use. J Shoulder Elbow Surg. 2002;11:389–400.PubMedCrossRef Neer CS 2nd. Four-segment classification of proximal humeral fractures: purpose and reliable use. J Shoulder Elbow Surg. 2002;11:389–400.PubMedCrossRef
21.
Zurück zum Zitat Neviaser AS, Hettrich CM, Dines JS, Lorich DG. Rate of avascular necrosis following proximal humerus fractures treated with a lateral locking plate and endosteal implant. Arch Orthop Trauma Surg. 2011;131:1617–1622.PubMedCrossRef Neviaser AS, Hettrich CM, Dines JS, Lorich DG. Rate of avascular necrosis following proximal humerus fractures treated with a lateral locking plate and endosteal implant. Arch Orthop Trauma Surg. 2011;131:1617–1622.PubMedCrossRef
22.
Zurück zum Zitat Owsley KC, Gorczyca JT. Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. J Bone Joint Surg Am. 2008;90:233–240.PubMedCrossRef Owsley KC, Gorczyca JT. Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. J Bone Joint Surg Am. 2008;90:233–240.PubMedCrossRef
23.
Zurück zum Zitat Shrader MW, Sanchez-Sotelo J, Sperling JW, Rowland CM, Cofield RH. Understanding proximal humerus fractures: image analysis, classification, and treatment. J Shoulder Elbow Surg. 2005;14:497–505.PubMedCrossRef Shrader MW, Sanchez-Sotelo J, Sperling JW, Rowland CM, Cofield RH. Understanding proximal humerus fractures: image analysis, classification, and treatment. J Shoulder Elbow Surg. 2005;14:497–505.PubMedCrossRef
24.
Zurück zum Zitat Sidor ML, Zuckerman JD, Lyon T, Koval K, Cuomo F, Schoenberg N. The Neer classification system for proximal humeral fractures: an assessment of interobserver reliability and intraobserver reproducibility. J Bone Joint Surg Am. 1993;75:1745–1750.PubMed Sidor ML, Zuckerman JD, Lyon T, Koval K, Cuomo F, Schoenberg N. The Neer classification system for proximal humeral fractures: an assessment of interobserver reliability and intraobserver reproducibility. J Bone Joint Surg Am. 1993;75:1745–1750.PubMed
25.
Zurück zum Zitat Siebenrock KA, Gerber C. The reproducibility of classification of fractures of the proximal end of the humerus. J Bone Joint Surg Am. 1993;75:1751–1755.PubMed Siebenrock KA, Gerber C. The reproducibility of classification of fractures of the proximal end of the humerus. J Bone Joint Surg Am. 1993;75:1751–1755.PubMed
26.
Zurück zum Zitat Sjoden GO, Movin T, Guntner P, Aspelin P, Ahrengart L, Ersmark H, Sperber A. Poor reproducibility of classification of proximal humeral fractures: additional CT of minor value. Acta Orthop Scand. 1997;68:239–242.PubMedCrossRef Sjoden GO, Movin T, Guntner P, Aspelin P, Ahrengart L, Ersmark H, Sperber A. Poor reproducibility of classification of proximal humeral fractures: additional CT of minor value. Acta Orthop Scand. 1997;68:239–242.PubMedCrossRef
27.
Zurück zum Zitat Solberg BD, Moon CN, Franco DP, Paiement GD. Locked plating of 3- and 4-part proximal humerus fractures in older patients: the effect of initial fracture pattern on outcome. J Orthop Trauma. 2009;23:113–119.PubMedCrossRef Solberg BD, Moon CN, Franco DP, Paiement GD. Locked plating of 3- and 4-part proximal humerus fractures in older patients: the effect of initial fracture pattern on outcome. J Orthop Trauma. 2009;23:113–119.PubMedCrossRef
28.
Zurück zum Zitat Solberg BD, Moon CN, Franco DP, Paiement GD. Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am. 2009;91:1689–1697.PubMedCrossRef Solberg BD, Moon CN, Franco DP, Paiement GD. Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am. 2009;91:1689–1697.PubMedCrossRef
29.
Zurück zum Zitat Sproul RC, Iyengar JJ, Devcic Z, Feeley BT. A systematic review of locking plate fixation of proximal humerus fractures. Injury. 2011;42:408–413.PubMedCrossRef Sproul RC, Iyengar JJ, Devcic Z, Feeley BT. A systematic review of locking plate fixation of proximal humerus fractures. Injury. 2011;42:408–413.PubMedCrossRef
30.
Zurück zum Zitat Stableforth PG. Four-part fractures of the neck of the humerus. J Bone Joint Surg Br. 1984;66:104–108.PubMed Stableforth PG. Four-part fractures of the neck of the humerus. J Bone Joint Surg Br. 1984;66:104–108.PubMed
31.
Zurück zum Zitat Sudkamp NP, Audige L, Lambert S, Hertel R, Konrad G. Path analysis of factors for functional outcome at one year in 463 proximal humeral fractures. J Shoulder Elbow Surg. 2011;20:1207–1216.PubMedCrossRef Sudkamp NP, Audige L, Lambert S, Hertel R, Konrad G. Path analysis of factors for functional outcome at one year in 463 proximal humeral fractures. J Shoulder Elbow Surg. 2011;20:1207–1216.PubMedCrossRef
32.
Zurück zum Zitat Thanasas C, Kontakis G, Angoules A, Limb D, Giannoudis P. Treatment of proximal humerus fractures with locking plates: a systematic review. J Shoulder Elbow Surg. 2009;18:837–844.PubMedCrossRef Thanasas C, Kontakis G, Angoules A, Limb D, Giannoudis P. Treatment of proximal humerus fractures with locking plates: a systematic review. J Shoulder Elbow Surg. 2009;18:837–844.PubMedCrossRef
33.
Zurück zum Zitat Trupka A, Wiedemann E, Ruchholtz S, Brunner U, Habermeyer P, Schweiberer L. [Dislocated multiple fragment fractures of the head of the humerus: does dislocation of the humeral head fragment signify a worse prognosis?][in German]. Unfallchirurg. 1997;100:105–110.PubMedCrossRef Trupka A, Wiedemann E, Ruchholtz S, Brunner U, Habermeyer P, Schweiberer L. [Dislocated multiple fragment fractures of the head of the humerus: does dislocation of the humeral head fragment signify a worse prognosis?][in German]. Unfallchirurg. 1997;100:105–110.PubMedCrossRef
Metadaten
Titel
Classifications in Brief: The Neer Classification for Proximal Humerus Fractures
verfasst von
Bradley C. Carofino, MD
Seth S. Leopold, MD
Publikationsdatum
01.01.2013
Verlag
Springer-Verlag
Erschienen in
Clinical Orthopaedics and Related Research® / Ausgabe 1/2013
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-012-2454-9

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