Neer, Am J Surg 1953 - Fracture of the Neck of the Humerus with Dislocation of the Head Fragment

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Fracture of the Neck of the Humerus with Dislocation of the Head Fragment

Neer, McLaughlin, et al.·Am J Surg·1953·153 citations·Case series

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A 1953 case series by Neer, Brown, and McLaughlin presenting 20 proximal humeral neck fractures with dislocation of the head fragment, asking: what is the best treatment for these rare, high-energy injuries when the head fragment is extruded and devoid of soft-tissue attachments?

Key Findings

Codman's four-fragment framework — head, greater tuberosity, lesser tuberosity, and shaft — provides the conceptual anatomy Neer would later formalize into his landmark 1970 classification system
Closed reduction succeeded only in impacted fractures, failing in every unimpacted lesion — a distinction with immediate operative implications:
- Impacted: 2/2 closed reductions succeeded
- Unimpacted: 4/4 closed reductions failed, all requiring head removal
Open reduction failed in all 3 unimpacted cases attempted, with avascular necrosis confirmed on 16-year follow-up radiograph — not a complication of technique, but of biology
Head resection was the most reliable treatment — 14 of 19 resection patients were satisfied and working — yet glenohumeral motion was only 5–25° regardless of adjunct soft-tissue reconstruction, exposing the fulcrum deficit that would motivate prosthetic replacement
Neer presents a prototype humeral replacement prosthesis (Figure 10) not yet used clinically at publication — the direct conceptual predecessor to his 1955 paper formally establishing shoulder arthroplasty

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Fracture of the Neck of the Humerus with Dislocation of the Head Fragment

Neer, McLaughlin, et al.·Am J Surg·1953·153 citations·Case series

|

A 1953 case series by Neer, Brown, and McLaughlin presenting 20 proximal humeral neck fractures with dislocation of the head fragment, asking: what is the best treatment for these rare, high-energy injuries when the head fragment is extruded and devoid of soft-tissue attachments?

Key Findings

Codman's four-fragment framework — head, greater tuberosity, lesser tuberosity, and shaft — provides the conceptual anatomy Neer would later formalize into his landmark 1970 classification system
Closed reduction succeeded only in impacted fractures, failing in every unimpacted lesion — a distinction with immediate operative implications:
- Impacted: 2/2 closed reductions succeeded
- Unimpacted: 4/4 closed reductions failed, all requiring head removal
Open reduction failed in all 3 unimpacted cases attempted, with avascular necrosis confirmed on 16-year follow-up radiograph — not a complication of technique, but of biology
Head resection was the most reliable treatment — 14 of 19 resection patients were satisfied and working — yet glenohumeral motion was only 5–25° regardless of adjunct soft-tissue reconstruction, exposing the fulcrum deficit that would motivate prosthetic replacement
Neer presents a prototype humeral replacement prosthesis (Figure 10) not yet used clinically at publication — the direct conceptual predecessor to his 1955 paper formally establishing shoulder arthroplasty

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