there are many divisions: foot and ankle, sports medicine, total joints,
spine, tumor, hand, shoulder and elbow, and pediatric orthopedics; but in
the 1940s, fracture care was just starting to be the first specialty of
orthopedics, undergoing a major metamorphosis due to a combination of
historic advances in metallurgy and antibiotics. As Dr. Neer entered
internship in 1942, penicillin was in its first year of use in the United
States, reversing a trend where any open fracture (bone poking through the
skin) was potentially lethal.
The act of operating in the era before antibiotics made any elective
operation risky. There was, therefore, almost no enthusiasm prior to the
immediate postwar epoch for insertion of any type of foreign material into
the human body. The track record of implanted ivory, bone, glass, metals,
plastics, and rubber was abysmal: almost every occasion of implantation
resulted in infection, necessitating removal. Today, we hear of fracture and
trauma patients undergoing fixation of broken bones on a regular basis;
this simply did not exist just a few generations ago. Like an invalid stroke
patient, fracture patients were placed in bed, with weeks or months passing
before getting in a wheelchair or standing bedside. With no possibility of
surgically reassembling the bone fragments, pioneering surgeons were
little better than ancient “bone-setters.” Instead of “fixing fractures,”
doctors would treat their supine patients with heavy plaster bandages and a
dizzying array of ropes, pulleys, splints, and overhead trapeze frames.
Dr. William Darrach was seventy years old, and newly retired from full-
time academic surgical practice when Dr. Neer returned from the Pacific
Theater. Dr. Darrach had been one of the world’s first great fracture
surgeons, and in the few years that their professional lives overlapped in
New York, the elder surgeon left an indelible mark on Neer’s career.
Decades later, Charlie Neer would still refer to Dr. Darrach as “my Chief.”
When Dr. Neer was a resident, he prepared his first publication,
“Intracapsular Fractures of the Neck of the Femur,” which was published
in the American Journal of Surgery in November 1948. This was
copublished with Harrison McLaughlin, MD, then the chief of the fracture
service at Columbia. Unusual for its time, the five-page article describes a
retrospective chart and X-ray review of 130 fracture patients over a
thirteen-year span (1932–44). All 130 patients suffered a hip fracture of
the femoral neck, and all of them were treated with the Smith-Petersen
nail, the metal plate and screws that were developed by the pioneering
marcin
(Marcin)
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