3. What is the Neer classification?
• What the two main components of the
classification?
4. What is the Neer classification?
1. Number of fracture parts
2. Displacement
5. How does the neer classification divide
the humerus?
6. How does the neer classification divide
the humerus?
• 4 parts
– 1. humeral head
– 2. Greater tuberosity
– 3. lesser tuberosity
– 4. humeral shaft
7. How does the Neer classification
displacement?
• Displacement = per part basis
• Fracture part = displaced if angulation >45
degrees OR if the fracture is displaced by >1cm
• Simplest displaced fracture = 2 part fracture,
HOWEVER a minimally displaced fracture even
with multiple fracture lines = type 1, one part
fracture
9. What is a one-part fracture?
1. Fracture line = 1-4 parts
2. None of the parts are displaced
NB. Type 1 = 70-80% of all proximal humeral
fracture – conservative treatment
11. Two Part Fracture?
1. Fracture lines = 2-4 parts
2. One part is displaced either angulation >45degrees or displaced
>1cm
Four possible type of 2part fractures exist for each division of the
humerus
1. Surgical neck (MOST COMMON)
2. Greater tuberosity (anterior shoulder disclocation). NB for GT #–
lower threshold for displacement (>5mm)
3. Anatomical neck
4. Lesser tuberosity – uncommon
2 part fractures = 20% proximal humeral fractures
14. 3 part fracture
1. Fracture lines: 3-4 parts
2. 2 parts displaced (>1cm OR >45 degrees)
Two 3-part # patterns exist
1. GT and shaft are displaced with respect to lesser
tuberosity and articular surface, which remain
together (MOST COMMON)
2. Lesser tuberosity and shaft are displaced with respect
to GT and articular surface, which remain together
5% proximal humeral #
16. 4 part #
• Fracture lines involve parts
• 3 parts = displaced >1cm or >45 degrees)with
respect to the 4th part
• Uncommon <1% of proximal humeral fractures
• Poor non-operative results, articular surface no
longer attached to any part of the humerus
• High incidence of AVN
Operative management required!!!
21. Classification of clavicle fractures?
What are the groups of clavicle fractures?
1. Group 1 – Middle third (80-85%)
2. Group 2 – Lateral Third (Neer classification of
the clavicle) (10-15%)
3. Group 3 – Medial third (5-8%)
24. How are group 1 # subdivided?
• Non-displaced – less than 100% displacement
– treated non-operatively
• Displaced >100% displacement (nonunion rate
4.5%) – treated operatively
25. How are group 2 classified (Neer)
• Type 1
• Type 2a
• 2b:
• 3
• 4
• 5
26. What is a Group 2 Type 1 fracture and
how is it managed?
27. What is a Group 2 Type 1 fracture and
how is it managed?
• Lateral to coracoclavicular (trapezoid and
conoid) ligaments OR is interligamentous
• USUALLY minimally displaced
• STABLE because conoid and trapezoid are
intact
• Non operative treatment
28. What is a Group 2, Type 2a #?
• # = medial to INTACT conoid and trapezoid
ligaments
• Medial clavicle UNSTABLE
• 56% = nonunion with nonoperative mx
• Treat operatively
30. What is G2, Type 2b
• Fracture = between ruptured conoid and
intact trapezoid OR lateral to both ligaments
TORN
• Medial clavicle UNSTABLE
30-45% nonunion with nociceptive management
Operative treatment
32. What is G2, Type 3
• Intrarticular – extends into AC joint
• Conoid and trapezoid = INTACT = STABLE
• Patients may develop post-traumatic AC
arthritis
• Test AC arthritis with scarf test
• Non-operative
34. G2, Type 4?
• Physeal fracture – skeletally immature
• Displacement of lateral clavicle occurs
superiorly – tear in periosteum
• Conoid and trapezoid overall remain attached
to periosteal sleeve and fracture is STABLE!
• Treatment therefore =NONOPERATIVE
35. G2, Type 5
• Comminuted #
• Conoid and trapezoid = attached to
comminuted fragment
• Medial Clavicle UNSTABLE
• OPERATIVE treatment
36.
37. Group 3 # - Medial 1/3
How is this category subdivided?
38. Group 3 # - Medial 1/3
How is this category subdivided?
• Anterior Displacement:
– Most often non-operative
– Rarely symptomatic
• Posterior Displacement:
– RARE
– Physeal fracture dislocation (<25yo)
– Stability depends on costoclavicular ligaments
– Potential for airway and great vessel compromise
– Surgical management with thoracic surgeon
48. What is Barton’s fracture (dorsal)?
• Distal radial fracture WITH dislocation of the
radiocarpal joint
• MOST COMMON # dislocation of the wrist
• Often occurs alongside a radial styloid fracture
• Operative treatment recommended – closed
reduction, application of external fixation plus
percutaneous pin insertion
• Or ORIF through dorsal approach
49. What is Barton’s fracture (volar)
• # volar margin of carpal surface of the radius
• Associated with SUBLUXATION of the
radiocarpal joint
• Comminuted # distal radius may involve
ant/post cortex
• More common than dorsal barton’s
54. Smith’s
• Types?
• Type 1: Extra-articular
• Type 2: crosses into the dorsal articular
surface
• Enters radiocarpal joint
• Volar barton’s # = Smith’s Type 3
55. Smith’s
• MOI: fall backwards onto palm of outstretched
hand
• Tx:
• ORIF for volar displaced #
• K wire for smith’s type 2
56. Chauffeur’s
• Radial styloid #
• MOI: Tension forces sustained through ulnar
deviation and supination of the wrist
• Strong radiocarpal ligament, avulses the radial
styloid from the metaphysis of the radius
• Associated Injuries: Scapholunate dissocation,
transstyloid perilunar dissociation, dorsal barton’s
58. Ankle Fractures
• Weber
• A
– BELOW level of ankle
– Tibiofibular syndesmosis intact
– Deltoid intact
– Medial malleolus OFTEN FRACTURED
– Usually stable
• B
– AT the level of the ankle joint, extending superiorly and laterally up the fibula
– Tibiofibular syndesmosis intact OR partially torn, WITHOUT widening of the distal tibiofibular
articulation
– Medial malleolus may be fractured or deltoid ligament may be torn
– Variable stability
• C
– ABOVE the level of ankle joint
– Tibofibular syndesmosis disrupted with WIDENING of distal tibiofibular articulation
– Medial malleolus fracture or deltoid ligament injury present
– Unstable: ORIF
