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Proximal humerus fracture in Adult
Other Resources UpToDate PubMed

Proximal humerus fracture in Adult

Contributors: Sahil Patel, Sandeep Mannava MD, PhD
Other Resources UpToDate PubMed


Causes / typical injury mechanism: Proximal humerus fractures most commonly occur in the elderly population, typically from ground level falls in the setting of osteoporosis or osteopenia. However, these fractures can also occur in younger patients from high-energy impacts.

Classic history and presentation: An elderly patient presenting with arm pain after a ground level fall on an outstretched arm in an attempt to brace themselves.

Prevalence: Accounts for 5%-6% of all adult fractures.
  • Age – most common in patients older than 65 years
  • Sex / gender – 2:1 female-to-male ratio
Risk factors: History of osteoporosis or osteopenia.

Pathophysiology: Osseous components of the proximal humerus become fractured or displaced, usually secondary to direct trauma. Traditionally, proximal humerus fractures have been classified by their component fractured parts: humeral shaft, humeral head, greater tuberosity, and lesser tuberosity.

Grade / classification system:
Neer Classification
In order to be classified as a fractured part, the fractured component needs to either be displaced greater than 1 cm or have angulation exceeding 45 degrees. The exception is the greater tuberosity, which is considered displaced at 5 mm.
  • One-Part Fracture
    • Fracture involves 1-4 parts
    • No parts are displaced
  • Two-Part Fracture
    • Fracture involves 2-4 parts
    • One part is displaced
  • Three-Part Fracture
    • Fracture involves 3-4 parts
    • Two parts are displaced
  • Four-Part Fracture
    • Fracture involves more than 4 parts
    • Three parts are displaced


S42.209A – Unspecified fracture of upper end of unspecified humerus, initial encounter for closed fracture

127286005 – Fracture of upper end of humerus

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Last Reviewed:09/26/2022
Last Updated:01/18/2024
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Proximal humerus fracture in Adult
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