Neer classification of proximal humerus fractures

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Classifies proximal humerus fractures by displaced parts.

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Escala de categorias

1-part 2-part 3-part 4-part

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Procedência e vigência

Órgão emissor: Orthopedic consensus
Versão: 1970
Ano: 1970
Família: léxico
Tipo de lógica: flat
Modalidade: XR, CT
Fonte primária: Displaced proximal humeral fractures (Neer)
Última verificação: 2026-06-26
Última checagem: 2026-06-26

Lógica de decisão

Forma estruturada (flat). Uma futura calculadora a lê; as categorias abaixo são a superfície legível.

Mostrar a lógica estruturada (JSON)

{
  "categories": [
    "1-part",
    "2-part",
    "3-part",
    "4-part"
  ]
}

Categorias num relance

Cat.	Significado	Conduta	Risco	Fonte
1-part	One-part Fracture lines may run through one to four of the anatomic segments, but no segment meets displacement criteria — every fragment is displaced less than 1 cm and angulated less than 45 degrees relative to the others. Treated as a single (minimally displaced) injury regardless of how many fracture lines are present; the soft-tissue envelope holds the fragments together.	Nonoperative: sling immobilization followed by early gentle, progressive rehabilitation. The overwhelming majority of proximal humerus fractures are minimally displaced one-part injuries and are managed conservatively with good functional results.	Generally favorable prognosis; osteonecrosis of the humeral head is uncommon because the head blood supply is usually preserved when fragments are minimally displaced.	okfonte StatPearls NBK470346, Treatment/Management — minimally displaced fractures managed with sling and progressive rehabilitation; corroborated by PMC3528923 (Carofino & Leopold, 'Classifications in Brief: The Neer Classification', CORR 2013), one-part definition.
2-part	Two-part Exactly one of the four anatomic segments (greater tuberosity, lesser tuberosity, or articular/head segment at the anatomic or surgical neck) is displaced beyond threshold — more than 1 cm of displacement or more than 45 degrees of angulation — while the remaining fragments stay within threshold.	Depends on which segment is displaced. Minimally displaced surgical/anatomic-neck patterns may be managed nonoperatively in a sling; significantly displaced two-part fractures (e.g., displaced greater tuberosity, often >5 mm, or displaced surgical neck) are commonly treated operatively with ORIF (plate/screws, intramedullary nail, or tension-band/suture fixation).	Lower osteonecrosis risk than three- and four-part fractures because at least three segments remain in continuity, preserving humeral-head perfusion; displaced greater-tuberosity fragments risk malunion and subacromial impingement if not reduced.	okfonte StatPearls NBK470346, Treatment/Management (sling for minimally displaced surgical/anatomic-neck fractures; operative indications for displaced fractures); two-part definition corroborated by PMC3528923.
3-part	Three-part Two segments are displaced beyond threshold — typically one tuberosity together with a displaced surgical-neck fracture (the articular segment stays attached to the remaining tuberosity), with displacement more than 1 cm or angulation more than 45 degrees.	Operative treatment is generally favored, especially in younger/active patients: open reduction and internal fixation (locking plate or intramedullary nail) to restore alignment and tuberosity position. Truly minimally displaced cases may be treated nonoperatively.	Higher osteonecrosis risk than two-part fractures because the articular blood supply is increasingly compromised as more segments displace. Published humeral-head avascular-necrosis rates for three-/four-part fractures vary widely by series and treatment (e.g. around 9% with conservative management); no single reliable per-type figure is established, and later work found fracture-part count alone does not consistently predict AVN.	okfonte StatPearls NBK470346, Treatment/Management (ORIF indicated for three-part fractures, particularly in younger patients); three-part definition, worsening vascular compromise, and the caveat that part-count does not consistently predict AVN from PMC3528923 (Carofino & Leopold, CORR 2013); ~9% conservative-treatment AVN from the systematic review PMC7444241.
4-part	Four-part All four segments — both tuberosities, the articular surface, and the shaft — are displaced beyond threshold (more than 1 cm or more than 45 degrees), leaving four separate displaced parts. The articular fragment is typically devascularized (except in valgus-impacted variants, where the medial periosteal hinge may preserve perfusion).	Operative: in elderly patients with poor bone quality or a devascularized head, arthroplasty (originally hemiarthroplasty, now frequently reverse total shoulder arthroplasty) is favored; in younger patients with reconstructable bone, ORIF may be attempted. Valgus-impacted four-part variants can be amenable to head-preserving fixation.	Highest osteonecrosis risk of the Neer types: Neer reported avascular necrosis of the humeral head in greater than 50% of classic four-part fractures, the rationale for primary arthroplasty in many elderly patients. Valgus-impacted variants carry a lower AVN risk.	okfonte StatPearls NBK470346, Treatment/Management (arthroplasty for four-part fractures and fracture-dislocations, head impression >40%/articular blood-supply loss); 'AVN in greater than 50% of these [classic four-part] fractures' and valgus-impacted exception from PMC3528923.

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