HUMERUS

HUMERUS
Location: Proximal segment (11)
BONE: HUMERUS (1)
Types:
A. Extra-articular, unifocal fracture (11-A)
Groups:
Humerus proximal segment, extra-articular unifocal
(11-A)
1. Avulsion of
3. Non2. Impacted
tuberosity
impacted
metaphysis
(11-A1)
metaphysis
(11-A2)
fracture
(11-A3)
B. Extra-articular, bifocal fracture (11-B)
Humerus, proximal segment, extra-articular bifocal
(11-B)
2. Without
1. With meta3. With
metaphyseal
physeal
glenohumeral
impaction
impaction
dislocation
(11-B2)
(11-B1)
(11-B3)
C. Articular fractures (11-C)
Humerus, proximal segment, articular fractures
(11-C)
1. Articular
3. Articular
2. Articular
fracture with
fracture with
fracture imslight displace- pacted with
glenoment impacted marked dishumeral disvalgus fracture
location
placement
(11-C1)
(11-C3)
(11-C2)
These fractures represent three part fractures, or fracture dislocations by the Neer classification.
© 2007 Lippincott Williams & Wilkins
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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)
2. Greater tuberosity displaced
1. Greater tuberosity not displaced
(11-A1.2)
(11-A1.1)
(1) superior,
(2) posterior
3. With glenohumeral dislocation
(11-A1.3)
(1) anterior and medial plus 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
2. With varus malalignment (11-A2.2)
(11-A2.1)
(1) pure medial impaction
(1) without sagittal malalignment
(2) posterior and medial impaction
(2) posterior impaction
(3) anterior and medial impaction
(3) anterior 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)
2. Simple with translation (11-A3.2)
1. Simple with angulation (11-A3.1)
(1) lateral
(2) medial
(3) with glenohumeral dislocation
3. Multifragmentary (11-A3.3)
(1) wedge
(2) complex
(3) glenohumeral dislocation
A3
S8
© 2007 Lippincott Williams & Wilkins
J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007
Humerus, proximal, extra-articular, bifocal, with metaphyseal impaction (11-B1)
2. Medial plus lesser tuberosity
1. Lateral plus greater tuberosity
(11-B1.2)
(11-B1.1)
(1) pure lateral impaction
(1) pure lateral impaction
(2) posterior and lateral impaction
(2) posterior and lateral impaction
(3) anterior and lateral impaction
(3) anterior and lateral impaction
Humerus
3. Posterior plus greater tuberosity
(11-B1.3)
B1
Humerus, proximal, extra-articular, bifocal, without metaphyseal impaction (11-B2)
1. Without rotatory displacement of
2. With rotatory displacement of the
the epiphyseal fracture fragment
epiphyseal fragment (11-B2.2)
(11-B2.1)
(1) greater tuberosity separated
(2) lesser tuberosity separated
3. Multifragmentary metaphysis plus
one of the tuberosities (11-B2.3)
(1) lesser tuberosity
(2) greater tuberosity
B2
Humerus, proximal, extra-articular, bifocal
1. “Vertical” cervical line plus greater
tuberosity intact plus anterior medial
dislocation (11-B3.1)
with glenohumeral dislocation (11-B3)
2. “Vertical” cervical line plus greater
tuberosity fracture plus anterior medial dislocation (11-B3.2)
3. Lesser tuberosity fracture plus posterior dislocation (11-B3.3)
(1) without anterior cephalic notch
(2) with anterior cephalic notch
B3
© 2007 Lippincott Williams & Wilkins
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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
malalignment (11-C1.1)
malalignment (11-C1.2)
3. Anatomical neck (11-C1.3)
(1) nondisplaced
(2) displaced
C1
Humerus, proximal, articular fracture impacted with marked displacement (11-C2)
1. Cephalotubercular with valgus
2. Cephalotubercular with varus
malalignment (11-C2.1)
malalignment (11-C2.2)
3. Transcephalic (double profile image
on x-ray) and tubercular, with varus
malalignment (11-C2.3)
C2
Humerus, proximal, articular fracture dislocated (11-C3)
2. Anatomical neck and tuberosities
1. Anatomical neck
(11-C3.2)
(11-C3.1)
(1) head impacted
(1) anterior
(2) head not impacted
(2) posterior
3. Cephalotubercular fragmentation
(11-C3.3)
(1) head intact
(2) head fragmented
C3
S10
© 2007 Lippincott Williams & Wilkins
J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007
Location: Diaphyseal segment (12)
BONE: HUMERUS (1)
Types:
A. Simple fracture (12-A)
Groups:
Humerus diaphyseal, simple (12-A)
1. Spiral
2. Oblique
(12-A1)
ⱖ30°) (12-A2)
(ⱖ
Humerus
3. Transverse
⬍30°) (12-A3)
(⬍
© 2007 Lippincott Williams & Wilkins
B. Wedge fracture (12-B)
Humerus diaphyseal, wedge (12-B)
1. Spiral wedge 2. Bending
(12-B1)
wedge (12-B2)
3. Fragmented
wedge (12-B3)
C. Complex fracture (12-C)
Humerus diaphyseal, complex (12-C)
3. Irregular
1. Spiral
2. Segmental
(12-C3)
(12-C1)
(12-C2)
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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)
2. Middle zone (12-A1.2)
1. Proximal zone (12-A1.1)
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
S12
© 2007 Lippincott Williams & Wilkins
J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007
Humerus diaphyseal, wedge, spiral (12-B1)
2. Middle zone (12-B1.2)
1. Proximal zone (12-B1.1)
Humerus
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)
2. Middle zone (12-B3.2)
1. Proximal zone (12-B3.1)
3. Distal zone (12-B3.3)
B3
© 2007 Lippincott Williams & Wilkins
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Humerus
J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007
Humerus diaphyseal, complex, spiral (12-C1)
(1) pure diaphyseal
(2) proximal diaphysio-metaphyseal
(3) distal diaphysio-metaphyseal
2. With 3 intermediate fragments
1. With 2 intermediate fragments
(12-C1.2)
(12-C1.1)
3. With more than 3 intermediate
fragments (12-C1.3)
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
(12-C2)
2. With 1 intermediate segmental and
additional wedge fragments (12-C2.2)
(1) pure diaphyseal
(2) proximal diaphysio-metaphyseal
(3) distal diaphysio-metaphyseal
(4) distal wedge
(5) 2 wedges, proximal and distal
3. With 2 intermediate segmental
fragments (12-C2.3)
(1) pure diaphyseal
(2) proximal diaphysio-metaphyseal
(3) distal diaphysio-metaphyseal
C2
Humerus, diaphyseal, complex irregular (12-C3)
1. With 2 or 3 intermediate
⬍4cm)
2. With limited shattering (⬍
fragments (12-C3.1)
(12-C3.2)
(1) 2 main intermediate fragments
(1) proximal zone
(2) 3 main intermediate fragments
(2) middle zone
(3) distal zone
3. With extensive shattering
⬎4cm)(12-C3.3)
(⬎
(1) pure diaphyseal
(2) proximal diaphysio-metaphyseal
(3) distal diaphysio-metaphyseal
C3
S14
© 2007 Lippincott Williams & Wilkins
J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007
BONE: HUMERUS (1)
Types:
A. Extra-articular fracture (13-A)
Groups:
Humerus distal segment, extra-articular (13-A)
1. Apophyseal
3. Meta2. Metaavulsion (13-A1) physeal
physeal multisimple (13-A2) fragmentary
(13-A3)
© 2007 Lippincott Williams & Wilkins
Humerus
Location: Distal segment (13)
B. Partial articular fracture (13-B)
Humerus distal segment, partial articular (13-B)
1. Lateral
3. Frontal (13-B3)
2. Medial
sagittal (13-B1) sagittal
(13-B2)
C. Complete articular fracture (13-C)
Humerus distal segment, complete
2. Articular
1. Articular
simple, metasimple,
physeal multimetaphyseal
simple (13-C1) fragmentary
(13-C2)
articular (13-C)
3. Articular,
metaphyseal
multifragmentary (13-C3)
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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)
2. Medial epicondyle, non-incarcerated 3. Medial epicondyle, incarcerated
1. Lateral epicondyle (13-A1.1)
(13-A1.3)
(13-A1.2)
(1) non-displaced
(2) displaced
(3) fragmented
A1
Humerus, distal, extra-articular metaphyseal simple (13-A2)
1. Oblique downwards 2. Oblique down3. Transverse (13-A2.3)
and inwards (13-A2.1) wards and outwards
(2) juxta-epiphyseal
(1) transmetaphyseal
(13-A2.2)
with posterior displacement (Kocher I)
(3) juxta-epiphyseal
with anterior displacement (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)
(1) lateral
(1) lateral
(2) medial
(2) medial
3. Complex (13-A3.3)
A3
S16
© 2007 Lippincott Williams & Wilkins
J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007
Humerus, distal, partial articular lateral sagittal (13-B1)
1. Capitellum (13-B1.1)
2. Transtrochlear simple (13-B1.2)
(1) through the capitellum (Milch I)
(1) medial collateral ligament intact
(2) between capitellum and trochlea
(2) medial collateral ligament ruptured
(3) metaphyseal simple (classic Milch II)
lateral condyle
(4) metaphyseal wedge
(5) metaphysio-diaphyseal
Humerus
3. Transtrochlear multifragmentary
(13-B1.3)
(1) epiphysio-metaphyseal
(2) epiphysio-metaphyseal-diaphyseal
B1
Humerus, distal, partial articular, medial sagittal (13-B2)
1. Transtrochlear simple, through
2. Transtrochlear simple, through the
medial side (Milch I) (13-B2.1)
groove (13-B2.2)
3. Transtrochlear multifragmentary
(13-B2.3)
(1) epiphysio-metaphyseal
(2) epiphysio-metaphyseal-diaphyseal
B2
Humerus, distal, partial articular, frontal (13-B3)
2. Trochlea (13-B3.2)
1. Capitellum (13-B3.1)
(1) simple
(1) incomplete (Kocher-Lorenz)
(2) fragmented
(2) complete (Hahn-Steinthal 1)
(3) with trochlear component
(Hahn-Steinthal 2)
(4) fragmented
3. Capitellum and trochlea (13-B3.3)
B3
© 2007 Lippincott Williams & Wilkins
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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
(1) Y-shaped
(13-C1.2)
(2) T-shaped
(1) Y-shaped
(3) V-shaped
(2) T-shaped
(3) V-shaped
3. T-shaped epiphyseal (13-C1.3)
C1
Humerus, distal, complete articular simple metaphyseal multifragmentary (13-C2)
2. With a fragmented wedge (13-C2.2)
1. With intact wedge (13-C2.1)
(1) metaphyseal lateral
(1) metaphyseal lateral
(2) metaphyseal medial
(2) metaphyseal medial
(3) metaphysio-diaphyseal-lateral
(3) metaphysio-diaphyseal-lateral
(4) metaphysio-diaphyseal-medial
(4) metaphysio-diaphyseal-medial
3. Complex (13-C2.3)
C2
Humerus, distal, complete multifragmentary (13-C3)
2. Metaphyseal wedge (13-C3.2)
1. Metaphyseal simple (13-C3.1)
(1) intact
(2) fragmented
3. Metaphyseal complex (13-C3.3)
(1) localized
(2) extending into diaphysis
C3
S18
© 2007 Lippincott Williams & Wilkins