A case of bone fracture with callus on the right femur of a chicken (Gallus gallus domesticus, L. 1758) from the ancient site of Dharih, Jordan.

Archaeozoology provides bones, which quite regularly present traces of fractures. These fractures are more or less at an advanced level of healing and bear witness to traumas or pathologies. These cases of palaeopathology are not always the subject of publications, which further restricts our knowledge about them. This short note allows the scientific community to be aware of an original case from an archaeological context in Jordan of a fracture on a hen's femur, consolidated by a callus and with displacement of the distal ends. Beyond the "anecdotal" aspect, and without imagining the circumstances in which the fracture occurred, the animal survived.

Impact of Intramedullary Nailing in the Treatment of Femur Fractures An Evolutionary Perspective.

Today intramedullary nails (IMN) are the gold standard in the treatment of femur fractures. Since its inception, improved design and understanding of the surrounding anatomy has exponentially increased successful patient treatment and outcomes by promoting early mobilization and reliable union. In this review, we provide an in-depth look into the evolutionary process that has led IMN to becoming today's gold standard in femur fractures.

Biographical background and origin of common eponymous terms in orthopedic surgery: anatomy and fractures in knee surgery.

An eponym is a person after whom an eponymous term is named. These eponymous terms are easy shorthand in communication between surgeons. Therefore, they are often used and hard to eradicate. We discuss eponymous terms that describe anatomical features and fracture types in the knee. With these terms, an overview of the historical background of the eponym and its current clinical implication is discussed. The eponymous terms discussed are Gerdy tubercle, Pellegrini-Stieda lesion, Segond fracture, Hoffa fracture and fat pad. The meaning of the eponymous term is clarified, the biography of the namegiver given and its contemporary clinical implication discussed. Since eponymous terms are used frequently in inter-collegial discussion and literature, the meaning should be clear for everyone, since otherwise it might give room for misunderstanding.

The contribution of intellectuals to the history of traumatology during the Renaissance: treatment of femoral fracture through François Rabelais' glossocomion.

During the Middle Ages and the Renaissance, intellectuals often included clinical cases and medical descriptions in their literary works. These authors appeared to be more interested in internal and infectious diseases rather than in musculoskeletal disorders and orthopaedics. François Rabelais (1490-1553) was one of the most renowned humanists and philologists of the sixteenth century. He was also a physician with an interest in translating ancient texts of medical authors. Rabelais rediscovered a device for treating femoral fracture originally described by the Roman physician Galen and named as glossocomion. Since the original apparatus had some imperfections, Rabelais redesigned and modified it. This new, improved version became a model for new devices for treating femoral fracture, as also reported by the great French surgeon Ambroise Paré. For this contribution, Rabelais deserves major consideration in the history of orthopaedics and traumatology.

History of traction for treatment of lower limb fractures.

The last two hundred years have seen the development of different systems of traction with effective methods of applying traction to the foot or to the leg for the treatment of fractures of the femur. The success of these methods has been tested during many wars by clinical evaluations but also by means of x-rays since the beginning of the twentieth century. Because of their advantages, these methods of traction were very frequent during the first part of the twentieth century. Crosby, Smith, Buck, Hodgen, Steinmann, Codivilla, Kirschner, and Pearson are names recurring daily on our fracture wards. Their concern for the welfare of their patients led to substantial improvements in the treatment of all patients with fractures.

History of femoral head fracture and coronal fracture of the femoral condyles.

The first known description of the coronal fracture of the lateral femoral condyle was published by Busch in 1869. Hoffa used Busch's drawing in the first edition of his book in 1888 and accompanied it only with one sentence. A full case history of this fracture pattern was described by Braun in 1891. However, Braun's article fell into oblivion and so the fracture was popularized only in the fourth edition of Hoffa's textbook, particularly thanks to the drawing, rather than the brief description. Therefore, a fracture of the posterior femoral condyle, or more specifically, of the lateral condyle, could properly be called "Busch-Hoffa fracture". Femoral head fracture was initially described by Birkett in 1869. Of essential importance in this respect were the publications by Christopher in 1924 and, particularly, Pipkin's study of 1957, including his classification that is still in use today. A historically correct eponym for a femoral head fracture would therefore be "Birkitt-Pipkin fracture".

Did Tutankhamun suffer from hypophosphatasia?--A hypothetical approach.

Between 2005 and 2010 new efforts have been undertaken to shed light on the life and death of Tutankhamun--for the first time with the aid of modern scientific methods like CT scans and DNA analysis. The publication of a paper in the Journal of the American Medical Association in February 2010, that stated the famous pharaoh died of a combination of Malaria and Köhler's disease II, provoked objections from various sides. Based on new and existing findings, the author has developed the theory that Tutankhamun might, instead, have suffered from hypophosphatasia, an inherited metabolic disorder that affects especially the musculo-skeletal system in many ways. Hypophosphatasia (HPP) can be highly variable in its clinical manifestations and can be difficult to diagnose. The author has compiled both medical and archaeological findings to support his theory and suggests that existing DNA samples of Tutankhamun and other members of his family should be tested for defects on the ALPL gene.

History and development of suction-irrigation-reaming.

Excessive intramedullary pressure coincident to surgical procedures requiring entrance and surgical manipulation within the intramedullary canal is a problem that was recognized by Gerhard Küntscher, the godfather of intramedullary nailing. He expressed concern about this phenomenon in his early writings during the 1940's. Although he suggested certain technical methods to moderate the event while doing the surgical procedure he had no solution for absolutely preventing its occurrence. This became more of an issue after he introduced motorized reaming in the mid 1950's to improve the strength of intramedullary fixation. The first to demonstrate that pressure could be avoided during intramedullary surgeries were Lorenzi, Olerud and Dankwardt-Lillieström in the late 1960's. Using a method that employed suction evacuation of intramedullary content prior to reaming, and by introducing irrigation while reaming, they were able to achieve negative pressures during their intramedullary work. They proved that if an IM technique did not inject fat throughout the bone and into the organism there were significant benefits both locally and systemically. With impeccable methodology, they showed fat destroyed the vascularity of the bone and inhibited its revascularization. Systemically, its presence was associated with death and morbidity. K.M. Stürmer, using sheep in studies done in the 1980's, further validated the effectiveness of negative pressure reaming to prevent adverse effects associated with reaming. The attempt to create a device to provide these benefits clinically, however, has been challenging. The group in Muenster did work with a rinsing-suction-reamer (RSR) that showed fat introduction with reaming need not be significantly greater than when using an external fixator. In the US, the effort has focused on developing a reamer that integrated suction and irrigation into its design. This instrument has been given the acronym of RIA (reamer/irrigator/aspirator). The rationale and development of this system is detailed in this paper. Now that the intramedullary canal can be reamed using a negative pressure method this domain, as a unique source of biological material, is being increasingly investigated. The cells and tissue harvested from this space have tremendous therapeutic promise.

Meurice Sinclair CMG: a great benefactor of the wounded of the First World War.

Major Meurice Sinclair was a Regular Army Medical Officer who revolutionised the management and treatment of gunshot fractures during the First World War, particularly those of the femur which carried the highest mortality. Not only did his methods reduce mortality but they increased the ease of nursing and hence the comfort of the wounded to a marked degree. His system of traction on the Thomas splint, in suspension, gained general acceptance such that he gave lectures and demonstrations to the medical officers of the allied forces, for which he was thrice mentioned in despatches and subsequently appointed CMG. Central to his method was the concentration of the fracture cases within certain hospitals to standardise and improve their management. This he was able to achieve through the good offices of Sir Almroth Wright who was Consultant Physician to the British Expeditionary Force. His methods reduced the death rate in open fractures of the femur from 80% generally, to 7.3% in his own hospital. He left a legacy that bore fruit both in the treatment of civilian fractures after the war but also in the second war of 1939-1945.

Perimortem weapon trauma in an adult male skeleton from the Italic necropolis of Opi Val Fondillo (VI-V century BC; Central Italy).

The author describes weapon traumatic lesions in an adult male skeleton, that was excavated in the Italic necropolis of Opi Val Fondillo, Central Italy. The preservation of the skeleton is very good. The skull shows a linear lesion across the diploE of the right parietal and occipital bones; the edge of the traumatic lesion is smooth and perpendicular to the bone surface. The injury was probably inflicted with a sharp-edged weapon and the violence of the stroke caused the detachment of bone fragments and fractures that radiate from the point of impact. A sharp-edged linear traumatic lesion, probably inflicted with a blade, is visible on the ventral surface of the vertebral bodies of atlas and axis; the blade detached the right transverse process of the atlas and penetrated in the vertebral body of the axis. Another sharp-edged linear traumatic injury is observed on the anterior surface of the body of thoracic vertebrae. There are no traumatic lesions of the ribs and the last injury was probably inflected down with a blade, while the body lying on the ground. The posterior surface of the diaphysis of the right femur shows an incomplete perimortem fracture, probably due to a compression down upon. Probably the adult male was killed during a fight and enemy had done with him, while he was lying on the ground holding fast his legs strongly. A comparison is made between the lesions and the modality of combat as well as the type of the weapons used by the Samnitic warriors.

Avulsed posterior edge of the tibia. Earle's or Volkmann's triangle?

The term Volkmann's triangle for the avulsed posterior edge of the tibia in fracture-dislocations of the ankle is incorrect. Volkmann did not publish any articles relating to the posterior edge of the tibia. Credit should go to Henry Earle, who was an outstanding British surgeon of the first half of 19th century. He described avulsion of the posterior edge of the tibia in 1828. In 1823 he also published a monograph entitled Practical observations in surgery in which he described a specially designed bed for the conservative treatment of proximal fractures of the femur.

Proximal femur fractures: the pioneer era of 1818 to 1925.

The foundations of the modern era of the treatment of proximal femur fractures were laid by Cooper who in 1819 published the first therapeutically oriented classification of these fractures. During the following 100 years the clinical diagnostics were further developed; five classifications of proximal femur fractures were formulated including the terminology used until now (peritrochanteric, intertrochanteric), and surgical treatment was started. The first attempt at internal fixation of the proximal femur in the 1850s was by Langenbeck. His patient died of sepsis. The first successful internal fixation of proximal femur fractures was done in 1875 by König. At the beginning of the twentieth century the method of surgical treatment for proximal femur fractures was improved by Lambotte, Delbet, and Putti. However, the time was not ready yet for this method of treatment. Only technologic progress (stainless steel, new technology), the additional development of anesthesia and asepsis, improvement of xray apparatus, and introduction of the traction table created the prerequisites for successful gradation of Smith-Petersen's method from 1925 to 1931, and which a few years later was used worldwide.