Comment on the Classics

Clinical Orthopaedics and Related Research has published two classic articles related to shoulder fractures in the past and we have reprinted both of them here to supplement this symposium on fractures of the proximal humerus. The earlier paper by Dr. John Wheeler Dowden from 1924 actually relates to the broader topic of early active motion in treating upper limb fractures. The principle involved in this kind of treatment is perhaps most applicable to fractures of the upper humerus. Dr. Dowden has illustrated this point by describing a patient who was a soldier wounded in World War I. A bullet passed through the man's upper arm at the level of the insertion of the deltoid, blowing away a portion of the humerus and leaving a wide gap in the arm. The patient "made a perfect recovery" without surgery after a course of treatment with regular active exercise. In the second classic article, Dr. Charles Neer has described his classification system for the evaluation and treatment of proximal humerus fractures. His system had the virtues of reproducibility and a high level of interobserver agreement. It conforms to Dr. Dowden's paper by defining that group of patients with proximal humerus fractures who most likely will recover well with the active exercise treatment program espoused by Dr. Dowden.