HUMERUS

BONE: HUMERUS (1) Location: Proximal segment (11)

Types:
A. Extra-articular, unifocal fracture (11-A) B. Extra-articular, bifocal fracture (11-B) C. Articular fractures (11-C)

Groups:
Humerus proximal segment, extra-articular unifocal Humerus, proximal segment, extra-articular bifocal Humerus, proximal segment, articular fractures
(11-A) (11-B) (11-C)
1. Avulsion of 2. Impacted 3. Non- 1. With meta- 2. Without 3. With 1. Articular 2. Articular 3. Articular
tuberosity metaphysis impacted physeal metaphyseal glenohumeral fracture with fracture im- fracture with
(11-A1) (11-A2) metaphysis impaction impaction dislocation slight displace- pacted with gleno-
fracture (11-B1) (11-B2) (11-B3) ment impacted marked dis- humeral dis-
(11-A3) valgus fracture location
placement
(11-C1) (11-C3)
(11-C2)

These fractures represent three part fractures, or frac-

ture dislocations by the Neer classification.

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Humerus J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007

Subgroups and Qualifications:

Humerus, proximal, extra-articular, unifocal tuberosity (11-A1)
1. Greater tuberosity not displaced 2. Greater tuberosity displaced 3. With glenohumeral dislocation
(11-A1.1) (11-A1.2) (11-A1.3)
(1) superior, (1) anterior and medial plus posterior
(2) posterior cephalic notch
(2) anterior and medial plus greater
tuberosity
(3) erecta and greater tuberosity
(4) posterior and lesser tuberosity

A1

Humerus, proximal, extra-articular, unifocal, impacted metaphyseal (11-A2)

1. Without frontal malalignment
(11-A2.1)
(1) without sagittal malalignment
(2) posterior impaction
(3) anterior impaction
2. With varus malalignment (11-A2.2)
(1) pure medial impaction
(2) posterior and medial impaction
(3) anterior and medial impaction
3. With valgus malalignment
(11-A2.3)
(1) pure lateral impaction
(2) posterior and lateral impaction
(3) anterior and lateral impaction

A2

Humerus, proximal, extra-articular, unifocal, non-impacted metaphyseal (11-A3)

1. Simple with angulation (11-A3.1) 2. Simple with translation (11-A3.2) 3. Multifragmentary (11-A3.3)
(1) lateral (1) wedge
(2) medial (2) complex
(3) with glenohumeral dislocation (3) glenohumeral dislocation

A3

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J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007 Humerus

Humerus, proximal, extra-articular, bifocal, with metaphyseal impaction (11-B1)

1. Lateral plus greater tuberosity
(11-B1.1)
(1) pure lateral impaction
(2) posterior and lateral impaction
(3) anterior and lateral impaction
2. Medial plus lesser tuberosity 3. Posterior plus greater tuberosity
(11-B1.2) (11-B1.3)
(1) pure lateral impaction
(2) posterior and lateral impaction
(3) anterior and lateral impaction

B1

Humerus, proximal, extra-articular, bifocal, without metaphyseal impaction (11-B2)

1. Without rotatory displacement of 2. With rotatory displacement of the 3. Multifragmentary metaphysis plus
the epiphyseal fracture fragment epiphyseal fragment (11-B2.2) one of the tuberosities (11-B2.3)
(11-B2.1) (1) greater tuberosity separated (1) lesser tuberosity
(2) lesser tuberosity separated (2) greater tuberosity

B2

Humerus, proximal, extra-articular, bifocal with glenohumeral dislocation (11-B3)

1. “Vertical” cervical line plus greater 2. “Vertical” cervical line plus greater 3. Lesser tuberosity fracture plus pos-
tuberosity intact plus anterior medial tuberosity fracture plus anterior me- terior dislocation (11-B3.3)
dislocation (11-B3.1) dial dislocation (11-B3.2) (1) without anterior cephalic notch
(2) with anterior cephalic notch

B3

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Humerus J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007

Humerus, proximal, articular fracture with slight displacement (11-C1)

1. Cephalotubercular with valgus 2. Cephalotubercular with varus 3. Anatomical neck (11-C1.3)
malalignment (11-C1.1) malalignment (11-C1.2) (1) nondisplaced
(2) displaced

C1

Humerus, proximal, articular fracture impacted with marked displacement (11-C2)

1. Cephalotubercular with valgus 2. Cephalotubercular with varus 3. Transcephalic (double profile image
malalignment (11-C2.1) malalignment (11-C2.2) on x-ray) and tubercular, with varus
malalignment (11-C2.3)

C2

Humerus, proximal, articular fracture dislocated (11-C3)

1. Anatomical neck 2. Anatomical neck and tuberosities 3. Cephalotubercular fragmentation
(11-C3.1) (11-C3.2) (11-C3.3)
(1) anterior (1) head impacted (1) head intact
(2) posterior (2) head not impacted (2) head fragmented

C3

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J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007 Humerus

BONE: HUMERUS (1) Location: Diaphyseal segment (12)

Types:
A. Simple fracture (12-A) B. Wedge fracture (12-B) C. Complex fracture (12-C)

Groups:
Humerus diaphyseal, simple (12-A) Humerus diaphyseal, wedge (12-B) Humerus diaphyseal, complex (12-C)
1. Spiral 2. Oblique 3. Transverse 1. Spiral wedge 2. Bending 3. Frag- 1. Spiral 2. Segmental 3. Irregular
(12-A1) ⱖ30°) (12-A2)
(ⱖ ⬍30°) (12-A3)
(⬍ (12-B1) wedge (12-B2) mented (12-C1) (12-C2) (12-C3)
wedge (12-B3)

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Humerus J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007

Subgroups and Qualifications:

Humerus diaphyseal, simple, spiral (12-A1)
1. Proximal zone (12-A1.1) 2. Middle zone (12-A1.2) 3. Distal zone (12-A1.3)

A1

ⱖ30°) (12-A2)
Humerus diaphyseal, simple, oblique (ⱖ
1. Proximal zone (12-A2.1) 2. Middle zone (12-A2.2) 3. Distal zone (12-A2.3)

A2

⬍30°) (12-A3)
Humerus diaphyseal, simple, transverse (⬍
1. Proximal zone (12-A3.1) 2. Middle zone (12-A3.2) 3. Distal zone (12-A3.3)

A3

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J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007 Humerus

Humerus diaphyseal, wedge, spiral (12-B1)

1. Proximal zone (12-B1.1) 2. Middle zone (12-B1.2) 3. Distal zone (12-B1.3)

B1

Humerus diaphyseal, wedge, bending (12-B2)

1. Proximal zone (12-B2.1) 2. Middle zone (12-B2.2) 3. Distal zone (12-B2.3)

B2

Humerus diaphyseal, wedge, fragmented (12-B3)

1. Proximal zone (12-B3.1) 2. Middle zone (12-B3.2) 3. Distal zone (12-B3.3)

B3

© 2007 Lippincott Williams & Wilkins S13

Humerus
Humerus diaphyseal, complex, spiral (12-C1)
(1) pure diaphyseal
(2) proximal diaphysio-metaphyseal
(3) distal diaphysio-metaphyseal
1. With 2 intermediate fragments
(12-C1.1)
C1
Humerus, diaphyseal, complex segmental
1. With 1 intermediate segmental
fragment (12-C2.1)
(1) pure diaphyseal
(2) proximal diaphysio-metaphyseal
(3) distal diaphysio-metaphyseal
(4) oblique lines
(5) transverse and oblique lines
C2
Humerus, diaphyseal, complex irregular (12-C3)
1. With 2 or 3 intermediate
fragments (12-C3.1)
(1) 2 main intermediate fragments
(2) 3 main intermediate fragments
C3
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2. With 3 intermediate fragments 3. With more than 3 intermediate
(12-C1.2) fragments (12-C1.3)
(12-C2)
2. With 1 intermediate segmental and 3. With 2 intermediate segmental
additional wedge fragments (12-C2.2) fragments (12-C2.3)
(1) pure diaphyseal (1) pure diaphyseal
(2) proximal diaphysio-metaphyseal (2) proximal diaphysio-metaphyseal
(3) distal diaphysio-metaphyseal (3) distal diaphysio-metaphyseal
(4) distal wedge
(5) 2 wedges, proximal and distal
⬍4cm)
2. With limited shattering (⬍ 3. With extensive shattering
(12-C3.2) ⬎4cm)(12-C3.3)
(⬎
(1) proximal zone (1) pure diaphyseal
(2) middle zone (2) proximal diaphysio-metaphyseal
(3) distal zone (3) distal diaphysio-metaphyseal
© 2007 Lippincott Williams & Wilkins
J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007 Humerus

BONE: HUMERUS (1) Location: Distal segment (13)

Types:
A. Extra-articular fracture (13-A) B. Partial articular fracture (13-B) C. Complete articular fracture (13-C)

Groups:
Humerus distal segment, extra-articular (13-A) Humerus distal segment, partial articular (13-B) Humerus distal segment, complete articular (13-C)
1. Apophyseal 2. Meta- 3. Meta- 1. Lateral 2. Medial 3. Frontal (13-B3) 1. Articular 2. Articular 3. Articular,
avulsion (13-A1) physeal physeal multi- sagittal (13-B1) sagittal simple, simple, meta- metaphyseal
simple (13-A2) fragmentary (13-B2) metaphyseal physeal multi- multifragmen-
(13-A3) simple (13-C1) fragmentary tary (13-C3)
(13-C2)

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Humerus J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007

Subgroups and Qualifications:

Humerus, distal, extra-articular apophyseal avulsion (13-A1)
1. Lateral epicondyle (13-A1.1) 2. Medial epicondyle, non-incarcerated 3. Medial epicondyle, incarcerated
(13-A1.2) (13-A1.3)
(1) non-displaced
(2) displaced
(3) fragmented

A1

Humerus, distal, extra-articular metaphyseal simple (13-A2)

1. Oblique downwards 2. Oblique down- 3. Transverse (13-A2.3)
and inwards (13-A2.1) wards and outwards (1) transmetaphyseal (2) juxta-epiphyseal (3) juxta-epiphyseal
(13-A2.2) with posterior displace- with anterior displace-
ment (Kocher I) ment (Kocher II)

A2

Humerus, distal, extra-articular metaphyseal multifragmentary (13-A3)

1. With intact wedge (13-A3.1) 2. With fragmented wedge (13-A3.2) 3. Complex (13-A3.3)
(1) lateral (1) lateral
(2) medial (2) medial

A3

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J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007 Humerus

Humerus, distal, partial articular lateral sagittal (13-B1)

1. Capitellum (13-B1.1)
(1) through the capitellum (Milch I)
(2) between capitellum and trochlea
2. Transtrochlear simple (13-B1.2) 3. Transtrochlear multifragmentary
(1) medial collateral ligament intact (13-B1.3)
(2) medial collateral ligament ruptured (1) epiphysio-metaphyseal
(3) metaphyseal simple (classic Milch II) (2) epiphysio-metaphyseal-diaphyseal
lateral condyle
(4) metaphyseal wedge
(5) metaphysio-diaphyseal

B1

Humerus, distal, partial articular, medial sagittal (13-B2)

1. Transtrochlear simple, through 2. Transtrochlear simple, through the 3. Transtrochlear multifragmentary
medial side (Milch I) (13-B2.1) groove (13-B2.2) (13-B2.3)
(1) epiphysio-metaphyseal
(2) epiphysio-metaphyseal-diaphyseal

B2

Humerus, distal, partial articular, frontal (13-B3)

1. Capitellum (13-B3.1) 2. Trochlea (13-B3.2) 3. Capitellum and trochlea (13-B3.3)
(1) incomplete (Kocher-Lorenz) (1) simple
(2) complete (Hahn-Steinthal 1) (2) fragmented
(3) with trochlear component
(Hahn-Steinthal 2)
(4) fragmented

B3

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Humerus J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007

Humerus, distal complete, articular simple, metaphyseal simple (13-C1)

1. With slight displacement (13-C1.1) 2. With marked displacement 3. T-shaped epiphyseal (13-C1.3)
(1) Y-shaped (13-C1.2)
(2) T-shaped (1) Y-shaped
(3) V-shaped (2) T-shaped
(3) V-shaped

C1

Humerus, distal, complete articular simple metaphyseal multifragmentary (13-C2)

1. With intact wedge (13-C2.1)
(1) metaphyseal lateral
(2) metaphyseal medial
(3) metaphysio-diaphyseal-lateral
(4) metaphysio-diaphyseal-medial
2. With a fragmented wedge (13-C2.2) 3. Complex (13-C2.3)
(1) metaphyseal lateral
(2) metaphyseal medial
(3) metaphysio-diaphyseal-lateral
(4) metaphysio-diaphyseal-medial

C2

Humerus, distal, complete multifragmentary (13-C3)

1. Metaphyseal simple (13-C3.1) 2. Metaphyseal wedge (13-C3.2) 3. Metaphyseal complex (13-C3.3)
(1) intact (1) localized
(2) fragmented (2) extending into diaphysis

C3

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