Charles S. Neer

Anterior Acromioplasty for the Chronic Impingement Syndrome in the Shoulder: A Preliminary Report

Impingement on the tendinous portion of the rotator cuff by the coraco-acromial ligament and the anterior third of the acromion is responsible for a characteristic syndrome of disability of the shoulder. A characteristic proliferative spur and ridge has been noted on the anterior lip and undersurfac

Displaced Proximal Humeral Fractures: Part I. Classification And Evaluation

On the basis of roentgenographic appearance and anatomical lesions in 300 displaced fractures and fracture-dislocations of the proximal end of the humerus, a new classification was made of these injuries. Existing classifications were found to be inadequate to describe the lesion encountered. The neOn the basis of roentgenographic appearance and anatomical lesions in 300 displaced fractures and fracture-dislocations of the proximal end of the humerus, a new classification was made of these injuries. Existing classifications were found to be inadequate to describe the lesion encountered. The ne

Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report.

In thirty-six patients (forty shoulders) with involuntary inferior and multidirectional subluxation and dislocation, there had been failure of standard operations or uncertainty regarding diagnosis or treatment. Clinical evaluation of these patients stressed meticulous psychiatric appraisal, conservative treatment, and repeated examination of the shoulder. All patients were treated by an inferior capsular shift, a procedure in which a flap of the capsule reinforced by overlying tendon is shifted to reduce capsular and ligamentous redundancy on all three sides. This technique offers the advantage of correcting multidirectional instability through one incision without damage to the articular surface. One shoulder began subluxating again within seven months after operation, but there have been no other unsatisfactory results to date. Seventeen shoulders were followed for more than two years.

Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement.

A study of 117 three-part and four-part displaced proximal humeral fractures, followed for from one to sixteen years, is presented. The ages of the patients averaged 55.3 years. Treatment began with closed reduction in seventy-seven patients, the result of which were accepted in thirty-one. Open reduction was done in forty-three patients, and prosthetic replacement in forty-three patients. Their results were rated by a numerical system. Closed reduction was found inadequate for active, healthy patients in either group. This was because of uncontrollable rotatory displacement in three-part fractures and avascular necrosis of the detached head in four-part fractures. Most of the poor results of open reduction in three-part displacements were due to errors in reduction or fixation while those in four-part displacements were due to avascular necrosis of the head. It. was concluded that the preferable method for three-part fractures was open reduction and that for four-part fractures was prosthetic replacement. Using these indications, the typical result was satisfactory but imperfect and many months were required for maximum recovery. Surgical errors and technique are discussed.

Replacement arthroplasty for glenohumeral osteoarthritis.

Forty-eight shoulders with glenohumeral osteoarthritis were treated by hemireplacement arthroplasty with a Vitallium humeral-head prosthesis in forty-seven patients, twenty-nine of whom were women. The results in an average follow-up of six years (range, one to twenty years) showed relief of pain and restoration of good function in nearly all patients. Recovery of adequate strength was slow, and continued fatigability was noted by some. Total shoulder-joint surface replacement was performed in one patient in this series with good early results.

Supracondylar Fracture of the Adult Femur: A Study Of One Hundred And Ten Cases

The clinical findings and pathological anatomy of 110 fractures through the lower three inches of the femur are presented. A classification based upon the type of displacement (Fig. 1) was thought to be more descriptive of the problem than the terms supracondylar and dicondylar alone. Each category presented clinical characteristics which are described. Seventy-seven fractures were followed for from one year to twenty-four years after injury. The results, graded by a numerical rating system, are considered according to anatomical classification. The results in patients treated by internal fixation are compared with those in patients treated by closed methods. No category of fracture at this level seemed well suited for internal fixation, and sufficient fixation to eliminate the need for external support or to shorten convalescence was rarely attained. The majority of serious local complications occurred after this form of treatment and, of twenty-nine patients so treated and evaluated, only 52 per cent obtained a satisfactory rating. Closed treatment yielded satisfactory results in 90 per cent of the forty-eight patients evaluated and in 84 per cent of those with displaced supracondylar fractures. Functional recovery was slow in patients with Group II-A and Group III injuries. Common errors in the management of tibial traction, noted during this study, supplemented by laboratory and cineroentgenographic observations, are discussed.

Treatment of Unicameral Bone Cyst: A Follow-up Study Of One Hundred Seventy-five Cases

A series of 175 unicameral bone cysts is presented. The pathogenesis of the lesion and the results of treatment differed depending upon the specific bone involved. It is our opinion that prompt surgical treatment to establish an accurate histological diagnosis and to reinforce the involved segment of bone against fracture by thoroughly evacuating the cavity and filling it with bone grafts is a more satisfactory treatment than watchful waiting. A persistent and static roentgenographic defect after surgery should not be considered a clinical failure if adequate bone strength is present. A second operation is indicated only for an enlarging cyst with the threat of fracture. In this series of 129 primary operations, the incidence of re-operation was 30 per cent in the proximal end of the humerus, 17 per cent in the proximal end of the femur, 1 1 per cent in the proximal end of the tibia, and nil in most of the other less frequent locations. In retrospect, a number of second procedures were considered unnecessary since they were performed for asymptomatic and static roentgenographic defects associated with sufficient bone strength to prevent fracture. True recurrence followimug surgical treatment is significantly more frequent in patients under ten years of age. Age is a more reliable prognostic criterion than the proximity of the cyst to the epiphyseal plate when assessing the likelihood of recurrence after surgical treatment.

The anatomy and potential effects of contracture of the coracohumeral ligament.

In 63 anatomic specimens of the shoulder, the coracohumeral ligament was found to be a clear, well-developed structure in 59 and absent or vestigial in four. The origin of the coracohumeral ligament was consistently found at the base of the coracoid process. The insertion was more variable, between the rotator interval, supraspinatus, and subscapularis. In fresh specimens, the coracohumeral ligament was tight with maximal external rotation, which increased an average of 32 degrees on sectioning this ligament only. The coracohumeral ligament has been found to be shortened in various pathologic states. Its release may be required to restore restricted external motion when doing arthroplasties or to allow adequate mobilization of the tendons when repairing retracted tears of the rotator cuff.

THE CLASSIC: Displaced Proximal Humeral Fractures: Part I. Classification and Evaluation

Charles Neer (Fig. 1) was born and raised in Vinita, Oklahoma. He obtained his undergraduate degree from Dartmouth, his medical degree from the University of Pennsylvania, and excelled in his orthopedic training at The New York Orthopaedic Hospital, Columbia–Presbyterian Medical Center, where he continues to practice as Professor of Orthopaedics. Although his interest has been in general orthopedics (he is still Chief of the Fracture Service at The New York Orthopaedic Hospital), in recent years his energies have been focused on the shoulder. The American Board of Orthopaedic Surgery and the American Academy of Orthopaedic Surgeons are indebted to him for his tireless committee work and significant contributions.

Chronic anterior dislocation of the shoulder

The treatment of 17 chronic, unreduced anterior dislocations of the shoulder was reviewed. Eleven women and six men with on average age of 67 years (range 36 to 88 years) were studied. The duration of dislocation averaged 2.3 years (8 weeks to 8 years). Seven patients were treated without surgery despite severe functional deficits, for reasons of health or motivation. Ten were treated with surgery. One patient with preserved joint surfaces underwent open reduction and corticoid transfer to bone graft an eroded anterior glenoid. Nine patients with destroyed articular surfaces underwent unconstrained replacement orthroplosty. Humeral retroversion was increased for stability. The soft tissues were reattached, and rehabilitation was modified as with a repair of recurrent dislocations. Anterior glenoid erosion was often present and required bone grafting to support the glenoid component in four shoulders. Two chronic rotator cuff tears required repair. Nine patients were followed from 2 to 6 years, with an average of 3.9 years. The results were four excellent, four satisfactory, and one unsatisfactory. Although the reconstruction is complex, the surgical results were clearly superior to those of the nonoperative group.