Fractures in late medieval skeletal populations from Serbia

Traumatic cubitus valgus consequent of distal humeral fracture: Two case studies from the Holocene Later Stone Age in southern Africa

OBJECTIVES

Distal fractures of the humerus and their complications have rarely been described or analysed in the palaeopathological literature. The objective of this study was to evaluate two cases of distal humeral fracture with associated cubitus valgus observed in two individuals from the context of the Later Stone Age (LSA) in southern Africa.

MATERIALS

Skeletal remains of two individuals. A middle-aged female radiocarbon dated to c.160 BP and a middle-aged male radiocarbon dated to c.2 300 BP.

METHODS

Remains were macroscopically and radiographically assessed for injury.

RESULTS

Both cases presented with healed antemortem injury to the right elbow attributed to possible falls. Distal humeral fracture resulted in non-union of the lateral epicondyle with extensive morphological changes to the elbow joint including an increased carrying angle. Morphological and osteoarthritic changes suggest a survival period of several years post-injury.

SIGNIFICANCE

Cubitus valgus following traumatic injury has rarely been reported amongst historic or prehistoric populations. The described injuries would have had physical and functional consequences, raising questions relating to probable care received during the healing process. The elbow injuries would have resulted in restricted motion and instability of the elbow joint, with a high likelihood of ulnar neuropathy.

LIMITATIONS

The contextual information for these individuals is limited and do not permit broader population level study.

SUGGESTIONS FOR FURTHER RESEARCH

Formal biomechanical analysis including cross-sectional geometry analysis will provide further information regarding complications and strengthen the diagnosis of ulnar neuropathy. Further research is necessary on the prevalence and complications of humeral fracture.

Thoracic trauma: Clinical and paleopathological perspectives

OBJECTIVES

Although trauma is one of the most significant areas of study in paleopathology, most studies focus on fractures of single anatomical elements. Paleopathological research on regional trauma, such as of the thorax, is rare. This paper explores the causes, complications, and consequences of adult thoracic trauma using clinical data in order to inform paleopathological research.

MATERIALS AND METHODS

Trends in paleopathological thoracic trauma literature were assessed by evaluating publications from Bioarchaeology International, International Journal of Osteoarchaeology, International Journal of Paleopathology, and American Journal of Biological Anthropology. Clinical publications on thoracic trauma throughout time were also assessed through a PubMed search, and modern prevalence data was found through trauma databases such as the National Trauma Databank.

RESULTS

Consideration of thoracic trauma involving concomitant injuries is a recent trend in clinical literature and patient care, but paleopathological research on thoracic trauma has been limited. Since thoracic fractures tend to occur in conjunction with other injuries, assessing them together is critical to the interpretation of trauma in the past.

CONCLUSIONS

Clinical research into thoracic fractures and concomitant injuries provides valuable data for paleopathological research. Evaluating the likelihood and consequences of concomitant injury in skeletal remains provides a more robust understanding of trauma in the past and its impact on past lifeways.

SIGNIFICANCE

This paper provides a review of current clinical and paleopathological literature on thoracic trauma and demonstrates the importance of moving beyond the analysis of fractures or trauma of single anatomical elements.

LIMITATIONS

Thoracic bones are often taphonomically altered and differentially preserved leading to difficulty in identifying and interpreting fractures.

SUGGESTIONS FOR FURTHER RESEARCH

Practical application of the data presented here to archaeological samples will help to advance paleopathological understandings of thoracic trauma.

Sex-Based Differences in Age-Related Changes of the Vertebral Column from a Bronze Age Urban Population in Ancient China

The health disparities between males and females in bioarchaeological settings are important indicators of gender-based differences in socioeconomic roles. In this study, sex-based differences of the vertebral column in spine pathology were investigated in human skeletons excavated from a Bronze Age cemetery of the Western Zhou Dynasty at the Dahekou site in Shanxi, China. Results demonstrated that females had a higher prevalence of vertebral compressive fractures, with the majority found in those between twenty-five and thirty years old, suggesting that the fractures were a consequence of osteoporosis and its early onset in females. In contrast, males expressed overall more severe ageing in all vertebral divisions compared to females. Males also had a higher prevalence of vertebral facet joint osteoarthritis in cervical and thoracic divisions than females. Likewise, the incidence of facet joint osteoarthritis was more asymmetric between the left and right joints in males than in females. These findings reflect disparities of vertebral health between the two sexes in an urban setting, in which ageing and injuries of the vertebral column might be driven by different mechanisms. Age-related changes in female vertebral columns may have been more influenced by conditions of hormone deficiency such as menopause, while male vertebral columns might have been more prone to age-related changes due to heavy labor-induced physical stressors. Further studies on the differentiation of ageing mechanisms between the two sexes based on physiology, socioeconomic roles, and living conditions are warranted. The studies are necessary in understanding how multiple sociocultural and physiological factors contribute to health disparities in historic and contemporary environments.

Toward a bioarchaeology of urbanization: Demography, health, and behavior in cities in the past

Urbanization is one of the most important settlement shifts in human history and has been the focus of research within bioarchaeology for decades. However, there have been limited attempts to synthesize the results of these studies in order to gain a broader perspective on whether or how urbanization affects the biology, demography, and behavior of humans, and how these potential effects are embodied in the human skeleton. This paper outlines how bioarchaeology is well-suited to examine urbanization in the past, and we provide an overview and examples of three main ways in which urbanization is studied in bioarchaeological research: comparison of (often contemporaneous) urban and rural sites, synchronic studies of the variation that exists within and between urban sites, and investigations of changes that occur within urban sites over time. Studies of urbanization, both within bioarchaeology and in other fields of study, face a number of limitations, including a lack of a consensus regarding what urban and urbanization mean, the assumed dichotomous nature of urban versus rural settlements, the supposition that urbanization is universally bad for people, and the assumption (at least in practice) of homogeneity within urban and rural populations. Bioarchaeologists can address these limitations by utilizing a wide array of data and methods, and the studies described here collectively demonstrate the complex, nuanced, and highly variable effects of urbanization.

A new approach to recording nasal fracture in skeletonized individuals

OBJECTIVE

This work describes a new method for recording nasal fracture in skeletonized individuals, suitable for use in biocultural studies of violence and fracture in past societies.

METHODS

The method consists in recording the 'side of fracture', 'side of deviation', 'type of fracture', 'other facial fractures', and stage of 'bone remodeling'.

RESULTS

A lateral impact force to the facial area is typical of interpersonal violence. This may result in a unilateral nasal fracture and/or a laterally deviated nose. Given the predominance of right-handedness in human populations, side of fracture and, especially, side of deviation, may be useful indices of interpersonal violence. As regards fracture type, although a distal fracture of the nasal bones is the most common type, their comminution may be associated with higher impact forces. The presence of other facial fractures may also be an indicator of high-energy impacts.

CONCLUSIONS

Different patterns of nasal trauma may be consistent with different etiologies.

SIGNIFICANCE

The method is focused at improving our ability to distinguish the direction and type of impact that caused the injury and, in particular, whether, at a population or sub-group level, such injuries are likely to be predominantly due to violence or to other causes.

LIMITATIONS

Well healed fractures of the nasal bones or injury to the septum may be difficult to identify. Also, it is not possible to confirm if nasal and other facial fractures are temporally concurrent.

SUGGESTIONS FOR FURTHER RESEARCH

To test this method using skeletal collections with known trauma history or 3D prints of modern nasal injuries of known etiologies.

Revisiting traumatic injury risk and agricultural intensification: Postcranial fracture frequency at Cerro Oreja in the Moche Valley of north coastal Peru

OBJECTIVES

In Lambert and Welker (2017) we explored the association between subsistence economy and postcranial fracture prevalence, finding that low-intensity agriculturalists exhibited significantly lower fracture rates than foragers or high-intensity agriculturalists. Here, we explore the impacts of sampling strategy on fracture rates in a sample of high-intensity agriculturalists from the Moche Valley, Peru, and further test the hypothesis that postcranial fracture risks are higher for intensive agriculture.

MATERIALS AND METHODS

The long bones and clavicles of 102 individuals from an Early Intermediate Period cemetery (400 B.C.-A.D. 200) at Cerro Oreja were examined for healed fractures. Sample composition was manipulated in six ways to investigate the effects of age and element completeness on estimates of fracture prevalence. Fracture rates at Cerro Oreja were then compared to those for other high-intensity agriculturalists.

RESULTS

Both skeletal element completeness and age composition were found to influence fracture rate estimates, reflecting the greater likelihood of identifying healed fractures on better-preserved bones and the accrual of injuries with age. The fracture rate of 3.4% at Cerro Oreja was the median value among seven high-intensity agriculturalist samples. The fracture distribution at Cerro Oreja was most similar to that observed at Kulubnarti, Sudan (Kilgore et al., 1997).

DISCUSSION

Skeletal element completeness and age composition can impact fracture rates estimated for skeletal samples and should be considered when conducting comparative analyses. All rates calculated for Cerro Oreja are within the range of those obtained for other high-intensity agriculturalists and support previous findings that traumatic injury risk is higher for high-intensity agriculturalists. Similarities between Cerro Oreja and Kulubnarti suggest that rugged terrain may exacerbate fracture risk for agriculturalists, illustrating the costs of intensive agriculture in suboptimal environments.

An accident at work? Traumatic lesions in the skeleton of a 4th millennium BCE "wagon driver" from Sharakhalsun, Russia

The study of ante-mortem trauma is a popular and important aspect of palaeopathological analysis. The majority of publications focus on a particular assemblage, skeletal element or type of fracture, with case studies of single individuals with multiple/unusual traumata being much rarer in the literature. This paper presents the case of an adult male from the Bronze Age site of Sharakhalsun, Russia, buried, uniquely, in a sitting position on a fully assembled wagon, who displayed evidence for multiple healed ante-mortem fractures of the cranium, axial and appendicular skeleton. The mechanisms and likely etiologies of the fractures are presented, with reference to modern and 19th century clinical literature, and possible interpretations suggested: that the individual was involved in a severe accident involving a wagon or draft animals, or both, a number of years before his death. The suggestion is also made that the unique burial position of the individual was a form of commemoration by the community of the survival and recovery of the individual from such a serious incident.

Post-Cranial Traumatic Injury Patterns in Two Medieval Polish Populations: The Effects of Lifestyle Differences

Traumatic injuries can be used as general indicators of activity patterns in past populations. This study tests the hypothesis that contemporaneous (10th-12th century) rural and urban populations in medieval Poland will have a significantly different prevalence of non-violent fractures. Traumatic injuries to the post-cranial skeleton were recorded for 180 adults from rural Giecz and for 96 adults from urban Poznań-Śródka. They were statistically analyzed by body region and individual skeletal element. Results reveal that Giecz had a significantly higher rate of trunk fractures than Poznań-Śródka (Fisher's exact, p<0.05). In particular, rib and vertebral fractures were more common in Giecz males and females than in their Poznań-Śródka counterparts. Traumatic injuries in the extremities were comparable between the two samples, suggesting similar risks of trauma to these regions. These results indicate that in early medieval Poland, activities associated with a rural lifestyle resulted in more injuries. These stress or accidental fractures, which are related to a high-risk setting, were not consistent with an urban lifestyle. Overall, agricultural populations like Giecz were engaged in a laborious lifestyle, reflected in a variety of injuries related to repetitive, high-risk activities. Although urban populations like Poznań engaged in craft specialization participated in repetitive activities, their lifestyle resulted in lesser fracture-risk.

Fatal cranial injury in an individual from Messina (Sicily) during the times of the Roman Empire

Forensic and archaeological examinations of human skeletons can provide us with evidence of violence. In this paper, we present the patterns of two cranial lesions found on an adult male (T173) buried in a grave in the necropolis 'Isolato 96', Messina, Sicily, dating back to the Roman Empire (1st century BC - 1st century AD). The skull reveals two perimortem traumatic lesions, one produced by a sharp object on the right parietal bone and the other one on the left parietal bone, presumably the result of a fall. The interpretation of fracture patterns found in this cranium are an illustration of how forensic approaches can be applied with great benefit to archaeological specimens.

Long bone fractures identified in the Joseon Dynasty human skeletons of Korea

Fracture is one of the pathological signs most frequently encountered in archaeologically obtained bones. To expand the paleopathological knowledge on traumatic injuries, it is desirable to secure data on long bone fractures from as wide a geographic and temporal range as possible. We present, for the first time, evidence of long bone fractures in a 16th-18th century Joseon skeletal series (n=96). In this study, we found 3 Colles' fractures of the radius in 2 individual cases. The pattern of fractures was unique. Although previous reports show that the ulna is broken more often than the radius, ulnar fracture associated with fending off a blunt attack was rare in our series (1/7 cases). Transverse fractures, typically caused by intentional violence, were also very rare (1/7 cases) in this study. These results may reflect the relatively tranquil lives of the Joseon people in 16th-18th century Korea. We also found post-fracture complications such as deformations, bone length shortening, and osteomyelitis. The present study would be of interest to medical scientists in related fields because it is one of the few studies conducted on long bone fractures among pre-modern societies in East Asian countries, thus far.

Compressive rib fracture: peri-mortem and post-mortem trauma patterns in a pig model

Despite numerous studies on high impact fractures of ribs, little is known about compressive rib injuries. We studied rib fractures from a biomechanical and morphological perspective using 15, 5th ribs of domestic pigs Sus scrofa, divided into two groups, desiccated (representing post-mortem trauma) and fresh ribs with intact periosteum (representing peri-mortem trauma). Ribs were axially compressed and subjected to four-point bending in an Instron 3339 fitted with custom jigs. Morphoscopic analysis of resultant fractures consisted of standard optical methods, micro-CT (μCT) and scanning electron microscopy (SEM). During axial compression, fresh ribs had slightly higher strength because of energy absorption capabilities of their soft and fluidic components. In flexure tests, dry ribs showed typical elastic-brittle behaviour with long linear load-extension curves, followed by relatively short non-linear elastic (hyperelastic) behaviour and brittle fracture. Fresh ribs showed initial linear-elastic behaviour, followed by strain softening, visco-plastic responses. During the course of loading, dry bone showed minimal observable damage prior to the onset of unstable fracture. In contrast, fresh bone showed buckling-like damage features on the compressive surface and cracking parallel to the axis of the bone. Morphologically, all dry ribs fractured precipitously, whereas all but one of the fresh ribs showed incomplete fracture. The mode of fracture, however, was remarkably similar for both groups, with butterfly fractures predominating (7/15, 46.6% dry and wet). Our study highlights the fact that under controlled loading, despite seemingly similar butterfly fracture morphology, fresh ribs (representing perimortem trauma) show a non-catastrophic response. While extensive strain softening observed for the fresh bone does show some additional micro-cracking damage, it appears that the periosteum may play a key role in imparting the observed pseudo-ductility to the ribs. The presence of fibrous pull-out and grooving of the outer tensile surface associated with periosteal stretching suggests that the periosteum under tension is able to sustain very high strain and bridge the mouth of the extending butterfly crack, thereby contributing to the observed strain-softening behaviour.

Adolescent health in medieval Serbia: signs of infectious diseases and risk of trauma

Although pattern of health in adults has been frequently assessed in past human populations, health status of adolescents as a distinct life stage has usually been overlooked. Inconsistency in number and meaning of recognised age categories in anthropological literature, as well as chronological age ranges used to define them, further complicate the interpretation of adolescent health. In this study, we analysed signs of pathological conditions on skeletal remains of 81 adolescents from a medieval site of Stara Torina (northern Serbia). Diagnostic palaeopathological procedures comprised gross examination, digital radiography, and histological analysis. Skeletal signs of anaemia such as cribra orbitalia and other porotic phenomena as well as signs of non-specific bone infection were observed frequently, while evidence of bone trauma was recorded in a very low percentage of individuals. In addition, we recorded two conditions relatively rarely observed in palaeopathological contexts: a case of skull and vertebral asymmetry indicative of congenital muscular torticollis, and a case of a fibrous cortical defect on distal femur. Comparison with available information from other medieval adolescent samples from Serbia demonstrated that while mortality was relatively constant throughout the sample, Stara Torina showed a much higher occurrence of bone disease. Characteristics of observed skeletal conditions, supported by available historical reports, suggest that the health of medieval adolescents in the examined population was most significantly affected by infectious processes.