Bridge (1931) offering access to the bedroom communities across the
Hudson.
Charlie Neer had arrived at Columbia at the perfect time. The mergers
of a medical school and university, the building of a campus and a bridge,
and the postwar boom provided an expanding patient population for his
observations. Reflecting fifty years later, Dr. Neer said, “When I was a
resident in orthopedic surgery [1946–9] at the New York Orthopedic,
Columbia-Presbyterian Medical Center, the only procedures used to treat
problems of the glenohumeral joint were fusions or resections to manage
tuberculosis, infections, and old injuries. I became interested in severely
displaced fracture-dislocations of the proximal humerus and made a study
of lesions of this type that had been treated ... with open reduction and
internal fixation, closed reduction, and removal of the humeral head.”^4
The few resources available to guide orthopedic resident Charlie Neer
in the treatment of shoulder fracture-dislocations provided no practically
useful information. Ernest Codman’s five-hundred-page-long magnum
opus, The Shoulder, focuses on the supraspinatus tendon and bursa, while
offering no effective treatment of shoulder arthritis and fractures. One can
hardly blame the Boston surgeon for his anemic ministrations; he would
die in 1940 without knowing about penicillin, screw fixation of broken
bones, or joint replacement. Regarding surgical treatment of fractures,
Codman only said, “... early operation is far more promising than if it is
delayed for even a few weeks. Surgical skill in handling fractures of the
head of the humerus will be displayed more in attaining rapid and
comfortable recovery than in ultimately securing good results, for nature
alone would produce them in most cases. Injudicious fixation is
responsible for most delays and failures in the recovery of normal
function.”^5 And that’s all—no technique recommendations, and certainly
no comment on implants: there were none in 1934.
The other main textbook available to Charlie Neer during his residency
was Arthur Steindler’s The Traumatic Deformities and Disabilities of the
Upper Extremity, published in 1946. Steindler, the chair of Orthopedic
Surgery at the University of Iowa, had published a book that was the most
comprehensive technique guide for shoulder, elbow, and hand surgery that
had ever been written; by today’s standards, it has almost nothing to say.
For treatment of shoulder fractures in which the humeral head had broken
and was dislocated, Steindler advised, “Incise along the axillary fold.