Neer's 1955 paper reports the first 12 cases of humeral head prosthetic replacement, performed for unreconstructable fracture-dislocations and avascular necrosis of the proximal humerus. It asks whether prosthetic replacement can succeed where head resection, reduction, and arthrodesis had all failed. This is the paper that created shoulder arthroplasty.
Every prior option had failed these patients. Reduction caused avascular necrosis (the head was stripped of soft-tissue attachments). Arthrodesis failed on necrotic or comminuted bone. Head excision eliminated the glenohumeral fulcrum, leaving a flail, painful joint.
When you see a four-fragment proximal humerus fracture-dislocation in a patient where the head is devoid of soft-tissue attachments, hemiarthroplasty is the answer — and this paper is why. Set retroversion at 20 degrees using epicondyle palpation, seat the implant completely, and start pendulum exercises at 48 hours.
Delayed reconstruction compounds the problem: Cases 2 and 6, treated months after injury, had the worst motion outcomes because extensive repair tissue had already formed. Early surgery matters.
The four-fragment pattern Neer described here directly seeded his 1970 proximal humerus fracture classification, which remains in clinical use today. Every time you stage a proximal humerus fracture by fragment count, you are working from anatomic observations first made in this paper.
Neer's 1955 paper reports the first 12 cases of humeral head prosthetic replacement, performed for unreconstructable fracture-dislocations and avascular necrosis of the proximal humerus. It asks whether prosthetic replacement can succeed where head resection, reduction, and arthrodesis had all failed. This is the paper that created shoulder arthroplasty.
Every prior option had failed these patients. Reduction caused avascular necrosis (the head was stripped of soft-tissue attachments). Arthrodesis failed on necrotic or comminuted bone. Head excision eliminated the glenohumeral fulcrum, leaving a flail, painful joint.
When you see a four-fragment proximal humerus fracture-dislocation in a patient where the head is devoid of soft-tissue attachments, hemiarthroplasty is the answer — and this paper is why. Set retroversion at 20 degrees using epicondyle palpation, seat the implant completely, and start pendulum exercises at 48 hours.
Delayed reconstruction compounds the problem: Cases 2 and 6, treated months after injury, had the worst motion outcomes because extensive repair tissue had already formed. Early surgery matters.
The four-fragment pattern Neer described here directly seeded his 1970 proximal humerus fracture classification, which remains in clinical use today. Every time you stage a proximal humerus fracture by fragment count, you are working from anatomic observations first made in this paper.