Proceed bluntly through the subcutaneous tissues. Expose the head by
blunt dissection and remove it.”^6 Unimaginably terse, removal of the
humeral head was the only option considered.
Shortly after Charlie Neer graduated, a breakthrough book by A. F.
DePalma, professor and head of Orthopedics at Jefferson Medical College,
was published in 1950. His book, Surgery of the Shoulder, was much more
descriptive, richly illustrated, and practically useful than anything that had
preceded it. Interestingly, there is no mention of penicillin or other
antibiotics in the text, and no discussion of infections. A few pages in this
lengthy tome dwell on fracture-dislocations of the shoulder, but as with
other orthopedic textbooks of the day, the treatment of humeral head
fractures is surprisingly crude. DePalma stated, “... removal of the head is
unavoidable, despite the realization that the procedure causes great
functional disability.”^7 Later in the book, he softens, asserting, “with
careful management, considerable control of the extremity and a
surprisingly good range of painless motion may be obtained.”^8
The most authoritative works of Charlie Neer’s early career all
concluded the same thing: when faced with a severe fracture-dislocation of
the shoulder, the only treatment available was extraction of the humeral
head, and the only proper emotional response was a resigned, flimsy hope
that a flail arm was better than an amputated arm.
Dr. Neer made his way up to the twelfth floor of the Columbia-
Presbyterian Medical Center to visit Mrs. Harrison. She had been admitted
to the Orthopedic Unit, awaiting surgery to have her humeral fracture
fragments surgically removed in a day or two. Charlie Neer, bald from
early adulthood but still athletically built, was accompanied by a few
residents who were in their late twenties, boasting of no war experience.
The small medical contingent shuffled into the elderly woman’s hospital
room, and Dr. Neer sat on the edge of her bed. Mrs. Harrison’s X-rays
divulged the severe nature of her injury: the upper portion of her humerus
was in multiple pieces, and the humeral head, like part of a Granny Smith
apple, was ripped in two. The fracture doctor needed to convey to the
patient how serious her injury was and what the treatment plan was.
“Mrs. Harrison, you have a terrible fracture of your arm. The humerus
bone is in many pieces.”
With her arm swathed against her body with a linen sheet, and with
broken eyeglasses and a fresh black eye from her fall, she was the very