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.

Trepanation to Treat a Head Wound: A Case of Neurosurgery from 13th-Century Tuscany.

During the archaeological excavations conducted in the 13th century cemetery of the Church of Sant'Agostino in Poggibonsi (Tuscany, Italy), a skull with evidence of neurosurgical intervention was brought to light. The skull, belonging to an adult male, shows two traumatic lesions produced by bladed instruments. The first lesion, located on the anterior part of the parietal bones, involved only the outer cranial table; bone remodeling indicates that the individual survived the injury for a long time. The second lesion, located on the frontal bone, involved all the thickness of the bone; the absence of reparative processes allows a diagnosis of peri mortem lesion. To treat this wound, the patient underwent surgical intervention. In fact, in correspondence to the lesion, an oval bone loss, with clean and well-defined cutting edges, can be interpreted as the result of a trepanation, probably performed to clean the wound and to remove any bone splinters. Half of the bone "rondella" was found in situ; it can be hypothesized that the surgeon decided to replace the bony piece to protect the brain. However, the surgical intervention failed, and the patient died soon afterwards. Trepanation for the treatment of cranial traumas is described by several medical classical and medieval authors, whose texts were available in the 13th century. This case represents rare Middle Ages evidence of neurosurgery used to treat a bone injury.

Corpus Hippocraticum: historical source of treatment of craniomaxillofacial trauma.

The works of Hippocrates known in the Western World as the Corpus Hippocraticum have dominated medical thought and surgical practice for centuries. A substantial part of the Hippocratic Collection is dedicated to the description of injuries pertinent to Cranio-maxillofacial surgery and their management. Hippocrates has reached this level of surgical skill despite the limited pre-recorded knowledge and the restriction of post-mortem dissections.

[COMPUTED TOMOGRAPHIC EXAMINATION OF CRANIAL LESIONS, A PALEORADIOLOGICAL APPROACH]. / KOPONYACSONT-LAESIÓK KOMPUTERTOMOGRÁFIÁS VIZSGÁLATA ÉS PALEORADIOLÓGIAI ASPEKTUSAI.

BACKGROUND AND PURPOSE: Introducing the multidisciplinary paleoradiology research at the Institute of Diagnostic Imaging and Radiation Oncology of the Kaposvár University, highlighting the cases with potential central nervous system involvement--from the scanning methods to the 3D printing--in order to draw attention to the historical background and clinical aspects of certain pathological conditions. METHODS: The authors developed the examination protocols for three different CT scanners. Among the examined archaeological remains cranial lesions were identified in 26 cases, from which 4 cases with potential central nervous system involvement are demonstrated. The scanning parameters and the advantages of secondary image reconstructions (multiplanar reconstruction, maximum intensity projection, three-dimensional volume rendering technique) are presented with the cases. RESULTS: The authors demonstrate a case with destructive skull lesions due to syphilis from the 15th century AD, a condition rarely seen or even unknown nowadays in the modern world. With the CT images of the skull base fracture from the Iron Age, signs of healing could be verified. Using the CT images a non-invasive approach is presented in the case of the craniofacial osteosarcoma in order to visualize the local status and the direct intracranial propagation. Advantages of the 3D VRT reconstructions are shown in the case of unilateral coronal suture synostosis. CONCLUSION: Paleoradiological CT examinations serve as a non-invasive, non-destructive tool for studying archaeological remains and artifacts. The special applications provided by the imaging modality contribute to the conventional paleopathological investigations.

John Howship (1781-1841) and growing skull fracture: historical perspective.

In the late 18th and early 19th centuries, Dr. John Howship, a pioneering British surgeon, described the clinical features and pathophysiology of various surgical disorders of the human body. His critical contributions to pediatric neurosurgery came in 1816 when he first described the features of an important childhood condition following head trauma, what he referred to as parietal bone absorption. This condition as depicted by Dr. Howship was soon to be christened by later scholars as traumatic cephalhydrocele, traumatic meningocele, leptomeningeal cyst, meningocele spuria, fibrosing osteitis, cerebrocranial erosion, and growing skull fracture. Nevertheless, the basic features of the condition as observed by Dr. Howship were virtually identical to the characteristics of the above-mentioned disorders. This article describes the life and accomplishments of Dr. Howship and his contributions to the current understanding of growing skull fracture.

Cranial vault trauma and selective mortality in medieval to early modern Denmark.

To date, no estimates of the long-term effect of cranial vault fractures on the risk of dying have been generated from historical or prehistoric skeletons. Excess mortality provides a perspective on the efficacy of modern treatment, as well as the human cost of cranial injuries largely related to interpersonal violence in past populations. Three medieval to early modern Danish skeletal samples are used to estimate the effect of selective mortality on males with cranial vault injuries who survived long enough for bones to heal. The risk of dying for these men was 6.2 times higher than it was for their uninjured counterparts, estimated through a simulation study based on skeletal observations. That is about twice the increased risk of dying experienced by modern people with traumatic brain injuries. The mortality data indicate the initial trauma was probably often accompanied by brain injury. Although the latter cannot be directly observed in skeletal remains, it can be inferred through the relative risks of dying. The ability to identify the effects of selective mortality in this skeletal sample indicates it must be taken into account in paleopathological research. The problem is analogous to extrapolating from death register data to modern communities, so epidemiological studies based on mortality data have the same inherent possibility of biases as analyses of ancient skeletons.

[Trepanations in the population of the Altai Mountains in the Vth - IIIrd centuries B.C].

The history of trepanations beginning with the Mesolithic (1 0-12 thousand years ago) is known by means of findings in various parts of the world. The article describes three cases of intravital trepanation of skulls from the Pazyryk Culture graves in the Altai Mountains that had existed from the end of the Vl'h to the beginning of the ll"d century B.C. In two cases, trepanations were performed so skillfully that the operated patients had survived for a long time after the surgery, which was confirmed not only by microscopy but also by MSCT of the skulls. The article establishes causes of surgeries performed, reconstructs the technique of surgical manipulations, and evaluates them in terms of modern medicine. A comparative analysis of ancient trepanations performed by healers of different archeological cultures is provided. It is concluded that prehistoric cranial surgeries in the Altai Mountains had been performed for curative purposes.

Different types of traumatic lesions on mediaeval skeletons from archaeological sites in Varese (North Italy): diagnosis on ante mortal fractures using macroscopic, radiological and CT analysis.

This is the medical history of three skeletons from archaeological sites in the province of Varese that are interesting because they show signs of traumatic injury to the skull and postcranial skeleton. Fractures of two of the skeletons were analysed by CT scan and radiological investigations to understand the extent of the damage and to hypothesise the cause. The study of lesions on ancient human remains is important to understand the degree of interpersonal violence within ancient communities and to reconstruct the dynamics of a violent episode.

Facial fractures in children: a historical perspective on treatment techniques.

The surgical principles for the treatment of facial fractures in children have evolved progressively over the past 70 years. In 1943 Waldron and colleagues published what is probably the first paper on the subject, thus setting a paradigm for the conservative treatment of pediatric facial fractures. This standard remained viable for about five decades. Therefore, during many years children with facial fractures did not benefit in the same manner as their adult counterparts from the multiple advances made in the management of facial trauma. In the 1990s craniofacial surgeons used plates and screws to correct craniofacial deformities in children with congenital malformations. As a consequence of their findings, pediatric oral and maxillofacial surgeons started to apply such principles to the management of facial fractures in young, growing patients, which eventually paved the way for the open reduction with external fixation paradigm. The aims of this article are to detail Waldron's initial directives, to evaluate the publications that contributed to its consolidation, and to analyze the factors that led to its challenge fifty years later.

The Colyer Collection of First World War dental radiographs and casts at the Hunterian Museum.

The Colyer Collection of First World War dental radiographs and casts is a unique teaching resource with a fascinating history. The story of the radiographs illuminates the role of dental surgery and Sir J. Frank Colyer (1866-1954) in the treatment of maxillofacial injuries during this period.

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.

Non-invasive examination of a skull fragment recovered from a World War Two aircraft crash site.

The discovery of human remains dating to the time of the Second World War is a common occurrence in Europe and the Pacific regions. This case report demonstrates the analysis of a bone fragment recovered from a Luftwaffe crash site in Austria during the summer of 2007. Eye-witness statements and official reports were used to reconstruct the historical background of the case. A recovered German military identity tag helped to identify the pilot. Aircraft parts, also discovered at the crash site in 2007, aided the identification of the aircraft type and corroborated the eye-witness reports of the final moments before and during the crash. The bone was analyzed chiefly to establish its human or non-human origin and to identify from which anatomic region the fragment could have arisen. It was identified as part of a human adult skull which exhibited peri-mortem fractures and heat damage as well as post-mortem vegetation staining. The historical background information in connection with the morphological analysis led to the presumptive identification of the cranial fragment as belonging to a downed German pilot.

Patterns of violence-related skull trauma in Neolithic Southern Scandinavia.

This article examines evidence for violence as reflected in skull injuries in 378 individuals from Neolithic Denmark and Sweden (3,900-1,700 BC). It is the first large-scale crossregional study of skull trauma in southern Scandinavia, documenting skeletal evidence of violence at a population level. We also investigate the widely assumed hypothesis that Neolithic violence is male-dominated and results in primarily male injuries and fatalities. Considering crude prevalence and prevalence for individual bones of the skull allows for a more comprehensive understanding of interpersonal violence in the region, which is characterized by endemic levels of mostly nonlethal violence that affected both men and women. Crude prevalence for skull trauma reaches 9.4% in the Swedish and 16.9% in the Danish sample, whereas element-based prevalence varies between 6.2% for the right frontal and 0.6% for the left maxilla, with higher figures in the Danish sample. Significantly more males are affected by healed injuries but perimortem injuries affect males and females equally. These results suggest habitual male involvement in nonfatal violence but similar risks for both sexes for sustaining fatal injuries. In the Danish sample, a bias toward front and left-side injuries and right-side injuries in females support this scenario of differential involvement in habitual interpersonal violence, suggesting gendered differences in active engagement in conflict. It highlights the importance of large-scale studies for investigating the scale and context of violence in early agricultural societies, and the existence of varied regional patterns for overall injury prevalence as well as gendered differences in violence-related injuries.

Diagnosis of contact injuries in a mediaeval skeleton analysed by µCT and histology.

During an archaeological excavation in Altenberg/Linz (Upper Austria), the well-preserved skeletal remains of a mature male dated the 13th century AD were recovered. Several elements of the skeleton yielded alterations caused by trauma: beside a malunion of the left ulna which was accompanied by shortening of the diaphysis, a luxation and deformation of the left radial head was observed (Monteggia-type lesion, Bado-type I). Moreover, at the anterior aspect of the corresponding humerus, a chalice-shaped, newly built bone structure that framed the displaced capitulum radii was visible. This structure formed a sort of "alternative joint" that functionally even allowed some movements, although considerably restricted in regard to flexion/extension and even more in pronation/supination.To verify the assumption of a "single event", we not only investigated the concerned skeletal portions by gross-anatomical examination, but also by non-invasive conventional radiological, micro-computed tomographical, and histological techniques. Particular morphological features, injuries at the calvarium, and fractures of other postcranial elements imply the scenario of a close combat; although survived, the traumata obviously resulted in partial invalidity.

Trauma and violence in the Later Stone Age of southern Africa.

BACKGROUND: Antemortem and perimortem fractures in skeletons recovered from Later Stone Age burials in southern Africa demonstrate that people were, on occasion, the victims of severe trauma attributable to interpersonal violence. METHODS: Case studies are presented of cranial vault depression fractures on 4 different individuals and a young adult female who had 2 bone arrowheads embedded in the lower vertebrae. These are compared with other cases from the literature. RESULTS: The evidence from the archaeological skeletons suggests that interpersonal violence was a regular occurrence among prehistoric foragers. Additional cases show healed fractures of other bones, but these probably represent injuries from day-to-day activities rather than violent conflict. DISCUSSION: The ethnographic depiction of the San as 'harmless people' is probably inaccurate, or, at best, only representative of the situation in northern Botswana in the 1960s. Damage to the bones indicates that the cause of the trauma was intentional violence. Explanatory models that suggest intense competition between hunter-gatherer groups are probably more accurate than ones that suggest that the groups were non-aggressive. CONCLUSION: Historical references to the San as aggressive and dangerous adversaries may be more accurate than revisionist historians have argued.