orthopedic surgeon from Harvard Marius Nygaard Smith-Petersen.
Thoughtful data presentation of patient profiles, disease states, and
rudimentary patient satisfaction was conveyed in fourteen tables.
Noticeably absent are the outcome measures, hip range of motion
numbers, and pain scores that modern orthopedic papers must exhibit.
However, the brilliance of reasoning, arrangement, and conclusion reveal a
prodigy in the making.
There are six conclusions in the hip fracture paper, the truths of which
today are set in stone:
- The best time for reduction and fixation of a hip fracture is
immediately. (There is no benefit in waiting for surgery.) - Good treatment for impacted valgus fractures of the femoral neck is
internal fixation and avoidance of bed stay. (Neer makes the assertion
that patients do better when bones are stabilized and the patient is
moved out of bed.) - Open reduction, properly done, is surer, shorter, and no more
dangerous than closed reduction and blind nailing. - Open reduction does not increase the incidence of subsequent aseptic
necrosis. (Surgery, by itself, does not cause bone death—it’s the
fracture that causes necrosis.) - Results are known only after objective evaluation. (Neer echoes the
great scientists and surgeons of the 17th and 18th centuries: Take no
man’s word for it.) - Almost all of the bad results of hip nailing are still the results of bad
hip nailing. (In this, Neer’s final sentence of his first paper, he makes
plain that technique matters.)
Charlie Neer completed his residency in 1949, shortly after the
publication of his hip fracture paper. He immediately became an assistant
professor in the Department of Orthopedic Surgery in Columbia
University’s College of Physicians and Surgeons on the Upper West Side
of Manhattan, and served on the Fracture Service, treating fractures from
the neck to the toes. Manhattanites could choose from several world-class
hospitals that proudly boasted of new fracture services. The newly
constructed Columbia-Presbyterian Medical Center in Morningside
Heights (completed in 1928) served the upper portion of Manhattan, the
Bronx, and even New Jersey, with the recently opened George Washington