Le fratture dell’estremo prossimale dell’omero: incidenza e classificazioni

Fractures of the proximal humerus are common and their incidence increases with age and, consequently, with the degree of osteoporosis. Over time, many classification systems regarding these fractures have been proposed. The aim of classification is to define a fracture on the basis of fixed parameters (morphologic characteristics and fracture pathoanatomy) that can be used for better understanding of fracture severity, prognosis and potential surgical options. Most classifications are based on the X-ray appearance of the humeral head fracture on plain films; recently 3D-CT scans have complemented traditional radiograms. Neer developed a classification system based on fracture pathoanatomy and on the presence or absence of displacement of one or more of the four major bony segments (surgical neck, anatomic neck, greater and lesser tuberosity). The AO classification system included the concept of perfusion of the articular segment. Edelson divided humeral head fractures into five basic types that correspond to some degree to the Neer classification, but differ significantly regarding the most complex patterns of fracture. Furthermore, an interobserver reliability study indicated the improved usefulness of the 3-D concept in providing a common language among clinicians for classifying these injuries. Finally, Hertel developed a classification system for better understanding the predictors of humeral head ischemia. In conclusion, a fracture must be classified for understanding its severity and guiding the treatment. Radiographies are often not sufficient for establishing the number of fragments and the entity of their dislocation. 3D-CT scans allow medial hinge condition and other predictors of humeral head ischemia to be better understood.