Shoulder
Proximal humerus fracture
Proximal humerus fractures are classified by counting displaced anatomical parts, where displacement means more than 1 centimetre of separation or more than 45 degrees of angulation.
What you are actually deciding
A fragment is only a "part" if it is displaced by the stated thresholds — a four-fragment fracture with no displacement is a one-part injury. Interobserver agreement is poor beyond the displaced-versus-minimally-displaced distinction, so treat finer subdivisions cautiously.
Clinical calculator1
Classification system2
- AO/OTA Classification3 itemsAO/OTA Fracture and Dislocation ClassificationThe AO/OTA classification gives every fracture an alphanumeric code in which the first digit is the bone, the second the segment and the letter the fracture type — extra-articular, partial articular or complete articular in an end segment, and simple, wedge or multifragmentary in a shaft — so that 32-A is a simple femoral shaft fracture and 43-C a complete articular pilon fracture.
- Neer Classification5 itemsNeer Classification of Proximal Humerus FracturesThe Neer classification sorts proximal humerus fractures into one-, two-, three- and four-part injuries by counting how many of the four anatomical segments — articular surface, greater tuberosity, lesser tuberosity and shaft — are displaced more than 1 cm or angulated more than 45°, with separate categories for fracture-dislocations and articular surface fractures.
Thresholds that apply here
Published change thresholds across the instruments above. Check the population matches your patient before using a value — a threshold derived in a different cohort will mislead you.
| Instrument | Type | Value | Subscale | Population |
|---|---|---|---|---|
| Constant Score | MCID | 10.4 points | — | Patients undergoing rotator cuff surgery |
See the full threshold database for every instrument on the site.