[Classification of fractures and problems in proximal humeral fractures]

Complex fractures of the proximal humerus may be difficult to assess and treat. Open or closed reduction and fixation may lead to malunion, nonunion, and/or avascular necrosis. Conversely, hemiarthroplasty also does not always result in satisfactory functional results. Various classifications have been established to compare the results of treatment and assist in decision making. The most commonly used classifications are those of Neer and the AO/ASIF group both of which appear to overestimate the relevance of avascular necrosis and underestimate the relevance of malunion. Because of the inter- and intraobserver variability in classifying these fractures, there is the potential for a wide variety of treatment recommendations, and predicting the prognosis becomes less accurate. Further work should be done in standardizing the classifications of proximal humerus fractures and defining the necessary X-ray projections.