The epidemiology of proximal humeral fractures

TLDR

Proximal humeral fractures occur mainly in fit elderly persons, with the highest age‑specific incidence in women aged 80–89. This 5‑year prospective study examined the epidemiology of 1,027 proximal humeral fractures. Fractures were classified using both Neer and AO systems to assess their comprehensiveness. The B1.1 impacted valgus fracture was the most common (≈20 % of cases), and the AO classification, which identified B1.1, A2.2, A3.2, and A1.2 sub‑groups as comprising over half of fractures, proved more comprehensive than Neer, indicating that current literature underrepresents the true spectrum of proximal humeral fractures.

Abstract

We present a 5-year prospective study of the epidemiology of 1,027 proximal humeral fractures. These fractures, which tend to occur in fit elderly persons, have a unipolar age distribution and the highest age-specific incidence occurs in women between 80 and 89 years of age. The commonest was the B1.1 impacted valgus fracture, found in one-fifth of the cases in this series, a type that is not included in the Neer classification. We used both Neer and AO classifications. The AO classification proved to be more comprehensive because in the Neer classification, half of the fractures are minimally displaced and almost nine-tenths fall into only three categories. In the AO classification, the B1.1, A2.2, A3.2 and A1.2 sub-groups comprise over half of all proximal humeral fractures, while the AO type C fractures occur in only 6%. We suggest that the literature does not adequately reflect the spectrum of proximal humeral fractures.