The history of bone marrow in orthopaedic surgery (part I trauma): trepanning, bone marrow injection in damage control resuscitation, and bone marrow aspiration to heal fractures.

PURPOSE: One of the oldest procedures performed by man is trepanning of the bone and yet it was only in the last 40 years that bone marrow aspiration has been used to treat nonunion disorders. MATERIAL AND METHODS: These advances were possible due to improvements in instruments and in techniques to make holes in the bone, an history that began with skull trephinations around 8000-10,000 years ago, and continued with sternum bone marrow injection for trauma resuscitation in the beginning of the twentieth century; this procedure had improved at the beginning of the twenty-first century to allow pelvis bone marrow aspiration for the treatment of nonunion. RESULTS: Trephined skulls from antiquity have been found in many parts of world, showing that trephining was ancient and widespread. Beginning with Neolithic period and the pre-Columbian Andean civilizations, the authors have traced the development of this surgical skill by describing the various surgical tools used to perform holes in the skull. These tools (trephines or trepan) were proposed at the end of the nineteenth century to study the bone marrow. At the beginning of the twentieth century, the sternum became the center of interest for the "in vivo" study of the bone marrow and the fluid injection in the sternum's bone marrow was described for resuscitation from shock during the World War II. With the introduction of plastic catheters and improved cannulation techniques, the need for intraosseous infusion as an alternative route for intravenous access diminished and sometimes abandoned. However, during the mid-1980s, James Orlowski allowed renaissance of the use of intraosseous infusion for paediatric resuscitation. Since then, this technique has become widespread and is now recognized as an alternative to intravenous access in adult emergencies; particularly, the intraosseous access has received class IIA recommendation from the Advanced Trauma Life Support program supported by the American College of Surgeons Committee on Trauma and bone marrow infusion is now recommended for "Damage Control" resuscitation. Although the pelvis bone contains half of the body's marrow volume, it was only in 1950 that the pelvis was proposed as a source for bone marrow aspiration and bone marrow-derived mesenchymal stem cells to improve healing of fractures. CONCLUSION: It will be many years before doing holes in the bone as orthopaedic trauma procedure will be relegated to the annals of history.

State of the art forensic techniques reveal evidence of interpersonal violence ca. 30,000 years ago.

The Cioclovina (Romania) calvaria, dated to ca. 33 cal ka BP and thought to be associated with the Aurignacian lithic industry, is one of the few relatively well preserved representatives of the earliest modern Europeans. Two large fractures on this specimen have been described as taphonomic modifications. Here we used gross and virtual forensic criteria and experimental simulations on synthetic bone models, to investigate their nature. Both forensic trauma pattern analysis and experimental models exclude a postmortem origin for the Cioclovina fractures. Rather, they indicate two incidents of blunt force trauma, the second clearly inflicted with a club-like object. The magnitude and extent of the lesions and the lack of signs of healing indicate a fatal injury. The Upper Paleolithic period is noted for intensified technological innovation, increased symbolic behavior, and cultural complexity. We show that the behavioural repertoire of the earliest modern Europeans also comprised violent inter-personal interactions and murder.

Abulcasis (936-1013): his work and contribution to orthopaedics.

AIM OF THE STUDY: The purpose of this historic review is to summarize the life and work of Abulcasis (936-1013) and his contribution to surgery and orthopaedics. METHOD: We conducted an extensive search in libraries as well as online in PubMed and Google Scholar. RESULTS: Abulcasis in his work combines the knowledge of ancient Greek and Roman physicians and surgeons with the extensive knowledge of Arabic medicine and pharmacology. He also pioneered surgical technique with the invention of numerous surgical instruments and with several revolutionary surgical techniques. CONCLUSION: Abulcasis made an impact with his medical writings in which he summarized the works of ancient Greek and Roman physicians like Hippocrates and Galen with the influence of medieval authors and the knowledge of the Arabic medicine and pharmacology. His descriptions and innovations in his work remained a work of reference in the West and East for many centuries to come.

Trauma in the upper limb of an Upper Paleolithic female from Caviglione cave (Liguria, Italy): Etiology and after-effects in bone biomechanical properties.

The impact of injury on the health and activities of human foragers is of great interest for understanding the adaptability of past populations to their environments. For the Gravettian female of Caviglione 1, a violent blow has been suggested as the origin of the left radial fracture, and abnormal body asymmetry has been observed. Access to high resolution CT-scans of the upper limb allows us to address new etiologic considerations and assess the after-effects of trauma on bone biomechanical properties by focusing on cortical and trabecular bones and conducting a comparative analysis of cross-sectional geometric properties in an Upper Paleolithic context. This originally right-dominant female, who became left-handed, was mainly affected by severe bone modifications on the proximal right humerus due to secondary changes following a traumatic event. The left radial fracture is very well consolidated with thick and homogeneous cortical bone. Etiological considerations point to a Galeazzi fracture for the left forearm occurring during a fall. The bone structure and robusticity of the left arm probably prove the lack of strong and enduring dependency of this female on her group for the usual cultural tasks despite the strongly limited function of the right arm.

Horse-riding accidents and injuries in historical records of Joseon Dynasty, Korea.

Only a few osteological reports describe bone injuries thought to have been caused by falls from horses. Nevertheless, anthropological study alone is insufficient for establishing the correlates of such equestrian accidents. We therefore reviewed the records in Seungjeongwon ilgi (Diaries of the Royal Secretariat) and Joseon wangjo silrok (Annals of the Joseon Dynasty) of the Korea's Joseon period (1392-1910 CE). Although the mechanisms of trauma were diverse, the Joseon documents recorded many injuries caused by horse-riding accidents. During 1625-1872 CE, equestrian-related accidents occurred almost every year, overwhelming other causes of trauma. In all horse-riding accidents (n=142), 37.77% of the records offer detailed data about the traumatic mechanism. Injuries occurred most frequently to the extremities (79.58%), which were followed by the trunk (34.5%) and head (4.92%). Although we do not think that this attempt can explain every paleopathological case, our historical review shows that equestrian-related injuries could be considered as one of the major causes for the bone trauma observed among ancient equestrian people.

History of external fixation for treatment of fractures.

Surgery in the first half of the nineteenth century was primarily dominated by pain and fear of lethal infections. Therefore, the absolute majority of fractures and dislocations were treated non-operatively. Development of operative treatment of fractures was influenced by three major inventions: anaesthesia (1846), antisepsis (1865) and X-rays (1895). The first to use external fixation is traditionally considered to be Malgaigne (1843). However, his devices cannot be really considered as external fixation. The external fixation device invented by Lambotte in 1902 is generally thought to be the first "real fixator". In America it was Clayton Parkhill, in 1897, with his "bone clamp" who started the process. Both Parkhill and Lambotte observed that metal pins inserted into bone were tolerated extremely well by the body. Mainly on the basis of their research findings, many external fixation devices have been and are being developed.

Trauma to the scull: an analysis of injuries in ancient skeletons from North West Lombardy archaeological sites.

Traumatic lesions are among the most important sources of data providing information associated to interpersonal violence within ancient populations. The investigation on weapon-related traumas on human remains allows us to reconstruct the dynamic of the violent episodes. The purposes of this study are to describe the types of skull traumas discovered in several skeletons from medieval necropolis of the North West Lombardy (8th-16th) and to examine their presence and distribution. The injuries observed in our osteoarchaeological collection were in the form of depressed and penetrated traumas. The injuries were revealed on the middle aged and older men, but also on women and subadult. Fractures of skulls were analysed with macroscopical and radiological observations. In particular, CT investigations were essential to understand the extent of the injury and to hypothesis the cause.

[The contribute of the trauma analysis to reconstruct the lifestyle of Castel Malnome community (Rome, I-II cent. A.C.)]. / Il contributo dell'analisi traumatologica nella ricostruzione dello stile di vita della comunita di Castel Malnome (Roma, I-II sec. D.C.).

The relations between fractures and living conditions of a population are important to reconstruct the biological status of a population. This work is focused on the description and interpretation of trauma in the skeletal remains: the sample consist of 218 individuals, coming from Roman imperial necropolis of Castel Malnome (I-II century AD). The trauma incidence has been considered by the calculation offrequencies per individual and per bone. The examination of the pattern offractures in the skeleton for this site indicates that the individuals are characterized by high level of trauma and reveals that ulna and ribs were the mostfrequently affected bones. The evidence of trauma in this population may reflect many factors about the lifestyle of individuals,for example their occupation and environmental conditions, moreover the state of healing of the injuries may also indicate the availability of treatments.

Bone fractures as indicators of intentional violence in the eastern Adriatic from the antique to the late medieval period (2nd-16th century AD).

To test the historically documented hypothesis of a general increase in deliberate violence in the eastern Adriatic from the antique (AN; 2nd-6th c.) through the early medieval (EM; 7th-11th c.) to the late-medieval period (LM; 12th-16th c.), an analysis of the frequency and patterning of bone trauma was conducted in three skeletal series from these time periods. A total of 1,125 adult skeletons-346 from the AN, 313 from the EM, and 466 from the LM series-were analyzed. To differentiate between intentional violence and accidental injuries, data for trauma frequencies were collected for the complete skeleton, individual long bones, and the craniofacial region as well as by type of injury (perimortem vs. antemortem). The results of our analyses show a significant temporal increase in total fracture frequencies when calculated by skeleton as well as of individuals exhibiting one skeletal indicator of deliberate violence (sharp force lesions, craniofacial injuries, "parry" fractures, or perimortem trauma). No significant temporal increases were, however, noted in the frequencies of craniofacial trauma, "parry" fractures, perimortem injuries, or of individuals exhibiting multiple skeletal indicators of intentional violence. Cumulatively, these data suggest that the temporal increase in total fracture frequencies recorded in the eastern Adriatic was caused by a combination of factors that included not only an increase of intentional violence but also a significant change in lifestyle that accompanied the transition from a relatively affluent AN urban lifestyle to a more primitive rural medieval way of life.

Concepts of orthopedic disorders in Avicenna's Canon of Medicine.

This manuscript offers a brief review of the orthopedic subjects in the Canon of Medicine. Highlights include, but are not limited to, the anatomy of the musculoskeletal system, fractures and dislocations, nerve and tendon injuries, different types of wounds and ulcers, and bone infections. Some of the concepts regarding musculoskeletal disorders remain relevant to current orthopedic knowledge. Reviewing the orthopedic subjects in the Canon of Medicine reveals that Avicenna has made a significant contribution to the evolution of orthopedic knowledge.

[The oldest treated bone fracture in Croatia--130,000 years ago]. / Najstariji izlijeceni prijelom kostiju u hrvatskoj--130,000 g.

BACKGROUND: Numerous hypotheses canibalismus on the cause of Neanderthal death have been proposed, including injury and inappropriate medical trreatment. We aimed to determine the etiology and pathogenesis of the Neanderthal by comparison of historical information with current clinicopathologic knowledge. INVESTIGATIONS: Evaluation of Neanderthal bones, original Dragutin Gorjanovic reports, and of historical documents. The clinicopathologic data from 135,000-year-old bones were used for comparison with the Mans bones. DIAGNOSIS: Diagnostic x-ray procedure for fractured bones with Siemens x-rays. CONCLUSIONS: Our analysis suggested successful healing of the fractures of the clavicle, radial bone and cranial bone trauma. Neanderthals treated successfully fracture and wounds and amputated forearm with poor result.

Evolution of pelvic and acetabular surgery from ancient to modern times.

Fracture stabilisation before the 19th century was in its infancy. The outcome was suboptimal, and quite often mortality was the end result. Advances in the stabilisation of long-bone fractures did not become apparent until the mid-1940s and for other bones, even later. In the mid-1960s, Judet and Letournel initiated a series of experimental and clinical studies focusing on pelvic and acetabular reconstruction surgery. Their work set the pace for all the subsequent advancements made in this field of surgery. Today, pelvic and acetabular reconstruction is a recognised subspecialty within the disciplines of trauma and orthopaedics. This review article traces the evolution of pelvic and acetabular surgery, from ancient to modern times.

Age-related cortical bone loss in women from a 3rd-4th century AD population from England.

Age-dependent cortical bone loss in adult females from a skeletal assemblage from 3rd-4th century AD England was studied using metacarpal radiogrammetry. Results showed reduced peak cortical bone thickness compared with modern subjects, and the magnitude of cortical bone loss in older females compared with their younger counterparts was greater than that documented for a modern reference population. An elevated prevalence of fractures classically associated with osteoporosis was also observed in the over-50-year cohort. The severity of osteoporosis in this group is difficult to explain in terms of extraneous factors relating to 3rd-4th century lifestyles. Given the important genetic component in osteoporosis, the results may indicate some inherent susceptibility in this particular population to the disease, and ways in which this possibility might be further explored are suggested.

[Ca and P supply of ruminants in the 19th and beginning of 20th century in Middle Europe]. / Zur Ca- und P-Versorgung der Wiederkäuer im 19. und beginnenden 20. Jahrhundert in Mitteleuropa.

The present review evaluates veterinary publications about some bone diseases in ruminants till 1925. According to more than 100 publications in some regions of Germany as well as in Scandinavian and Westeuropean countries during the 19th century several cases of bone fractures in ruminants were reported, mainly in pregnant and lactating cattle and goats. From a recent point of view and after feed analyses this disease obviously was caused by a P-deficiency. Bone fractures sometimes were accompanied by licking behaviour, but in other regions pica (without severe skeletal deformations) was probably related to a Cu- or Co-deficiency. Swelling of the jaws (probably by Ca-deficiency) was exclusively described in goats. By preventive measures (feeding bone meal, P-fertilisation) bone fractures diminished in the beginning of the 20th century. After the experience in the past in ruminants bone diseases may come back, if effective preventive measures will be ignored due to the recent trends towards 'natural farming'.

Fractures in medieval Scotland.

The prevalence of fractures in medieval Scotland is assessed, particular attention being given to excavations of cemeteries beside three Carmelite cemeteries, at Aberdeen, Perth and Linlithgow, and another one at Whithorn Abbey. In the friaries the prevalence of fractures was 7.6% and in Whithorn it was 5.0%. These figures are comparable with an estimated prevalence of 7.2% for individuals between 0 and 65 years in present day Scotland. Males were more at risk of fractures than females, but a small group from both genders had been struck on the head by weapons. A study from a rural cemetery in England indicates that both male and female peasants had a much higher risk of fractures than their urban counterparts.

Electrical bone graft stimulation for spinal fusion: a review.

Although electrical stimulation to aid bone fusion is well established in the treatment of long-bone fractures, its use as an aid in spinal fusion is not as well documented. This article presents the history and scientific basis of electrical stimulation to aid bone fusion and extensively reviews the clinical literature. It is intended to provide an objective review of the indications and limitations of electrical stimulation to enhance spinal fusion and to serve as a reference source for further study.