Similar to the hip fracture paper he had published a few years before,
this chart review project required herculean effort, poring through
logbooks from the Fracture Service and the operating room. Charlie Neer
wanted to evaluate every shoulder fracture and dislocation (or both) that
had darkened the doors of the New York Orthopedic Hospital over a
twenty-three-year period (from 1929 to 1951), and determine how many of
those injuries involved a fracture, and subsequent dislocation, of the
humeral head. A young physician performing this project today would
contact her medical records department, submit the ICD-10 code (the
national standard diagnosis code, e.g., S42.241A for a severe fracture of
the right proximal humerus), and the information technology department
would, in a matter of minutes, churn out a list of every patient in that
category, replete with their demographic information and hospital number.
Armed with these particulars, a skilled data-miner could generate a
treasure trove of information from any computer, opening the hospital’s
electronic medical records and imaging software. Dr. Neer, instead, needed
to summon the skillset of an archeologist, scratching through opaque,
coffee table–size logbooks with single-line handwritten entries of patients,
with the briefest of descriptions of their names, dates of birth, and
fractures.
Every available moment away from patient care was spent delving into
the medical histories of shoulder fracture and dislocation patients over the
life of the Columbia-Presbyterian Medical Center. Those patients who had
suffered simple shoulder fractures were carefully tabulated but not
investigated. He knew that most of those patients recovered reasonably
well, without the need for surgery. Additionally, those who had
experienced dislocations of the shoulder joint were chronicled, but again,
not intensively evaluated. Dr. Neer was searching for the patients who had
suffered the diabolical combination of a shattered proximal humerus and a
dislocation of the humeral head. Slowly, the tedious work of searching
through the medical records started to yield the occasional patient who had
fallen victim to the terrible amalgamation. After months of chart review,
Dr. Neer (and his helpers) had identified 1,796 total patients who had been
afflicted with shoulder trauma at the hospital over twenty-three years.
More than half of those patients (51.2 percent, or 921 patients) had
suffered a fracture of the neck of the humerus. A total of 784 patients had
dislocated their shoulders (44 percent of all patients seen at the hospital),
marcin
(Marcin)
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