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The four-part fracture occurs in two forms. In the (A) classic four-part fracture, the articular surface of the head is no longer in contact with the glenoid. In the (B) valgus impacted fracture, the humeral head is driven down and the tuberosities splay out. (Reprinted with permission from Elsevier from Neer CS 2nd. Four-segment classification of proximal humeral fractures: purpose and reliable use. J Shoulder Elbow Surg. 2002;11:389–400.)
