and 71 patients had endured a fracture of the tuberosity (the large bump at
the top of the humerus where the rotator cuff tendons attach). Of all the
patients treated at Columbia-Presbyterian, only 20 had fractured and
dislocated the proximal humerus, representing only 1.1 percent of all
shoulder trauma patients. Less than one patient per year had fallen victim
to the condition that would be the focus of Charlie Neer’s first shoulder
publication, but the most significant impact of his inaugural shoulder
paper was to illuminate how poorly those twenty patients had responded to
the treatment of the day.
“Fracture of the neck of the humerus with dislocation of the head
fragment” was published in the March 1953 issue of the American Journal
of Surgery, authored by Charles Neer, Thomas Brown, and Harrison
McLaughlin.^9 After identifying the twenty patients of interest, an analysis
was performed. The average age was fifty-six (what the authors described
as being “midway between young and old”), and the typical mechanism
was a fall from a standing height. Regarding treatment, in only two
instances was closed treatment (no surgery) the final remedy. In three
instances an attempt was made to surgically save the humeral head and
reassemble the fragments together, and in a lone patient the surgeons had
effected a fusion of the humerus to the shoulder socket.
Of the original twenty patients, sixteen underwent excision of the
humeral head. In some of these patients, parts of the muscles and tendons
were sewn to the broken top of the humeral shaft, not too different than
someone duct-taping a car’s side mirror back to its base after a vehicular
accident. In the results section of the paper, the authors outlined average
follow-up time and the level of patient satisfaction. In what is perhaps the
most profound sentence of the publication, the surgeons concluded: “There
was usually from 5 to 25 degrees glenohumeral motion following head
removal regardless of whether or not a [reconstructive] procedure had
accompanied the [humeral head] resection.”
If a regular patient lifts his hand straight up in the air, evaluators would
describe that as 160 degrees forward flexion; in the 1953 article, the
typical patient barely had enough power to lift her hand imperceptibly
away from the body. In other words, the wounded had essentially ended up
with ankylosed, or fused shoulders.
Just a couple generations ago, chronic tuberculosis and trauma savaged
many denizens of cities like New York, and a useless limb was all too