Dr. William Simon: This 15-year-old schoolboy entered the emergency room of the Massachusetts General Hospital one hour after sustaining an injury to the left shoulder. The patient had been playing football and, after making a block, fell on the left shoulder. He had been in good health prior to the injury. There was a history of hypersensitivity to penicillin.
At the time of physical examination, he appeared as a healthy boy with the left upper extremity supported in a sling. There was no compromise of neurovascular supply to the left hand or forearm. The left shoulder was markedly swollen and diffusely tender over the proximal humerus. Any motion of the shoulder exaggerated pain. The arm was held at the side in slight abduction.
Roentgenograms were taken which showed an epiphysial fracture of the proximal left humerus with a large metaphysical component (Fig 1).
Following a sedative dosage of meperidine hydrochloride,