A Healed Intertrochanteric Femur Fracture, Shoulder, and Rib Fractures in an Ancient Nubian Female: An Osteoarchaeological Perspective.

This report is a case of a healed proximal intertrochanteric femur fracture nonunion in an ancient Nubian adult female, approximately 58 years old at the time of death, from the Tombos archaeological site in present day northern Sudan. Tombos was founded as an Egyptian colonial town during the New Kingdom Period (14001070 BC). The individual was radiocarbon dated to 1114-910 BC and also exhibited healed fractures of the left proximal humerus and ribs. There was shortening and mild atrophy of the right femur compared to the left; radiographs demonstrated a varus deformity of the proximal femur with associated retroversion. Bone density analysis revealed that the tissue mineral density z-score for this individual was -0.798, with the z-score for Tombos females 15-24 years old being 0.396, or a total difference of 1.194. This indicates that the individual was osteopenic but not osteoporotic prior to demise. This is an important case as it occurred approximately 3000 years ago and is the oldest known reported case of a healed intertrochanteric hip fracture in the archaeological literature. Archaeological cases of intertrochanteric hip fractures are rare, with none previously reported from the BC era. The timing of these multiple fractures is unknown, but all healed before the demise of the individual. Thus, there must have been considerable care afforded to such an individual to minimize the morbidities associated with nonoperative care of such a fracture. If all these fractures occurred at the same time due to a traumatic, accidental injury, the Modified Injury Severity Score (MISS) would be 25. Modern day trauma resuscitation and orthopaedic care gives an estimated mortality for such a MISS score of 28% for those <50 years old. It is likely that this individual's high socioeconomic status allowed for intensive nursing care which likely decreased the morality risk.

Massive bone destruction in a human proximal femur from ancient Nubia.

Massive bone destruction in a human right proximal femur is described and differentially discussed in this case study. The individual was an older adult female buried at the ancient Nubian site of Tombos (modern-day Sudan) dating to the early Napatan/Third Intermediate Period (c. 1069-750 BCE). The right femur displayed a pathologic fracture with extensive lytic destruction and resorption of the entire femoral neck, most of the femoral head, and trochanters. Macroscopic and radiographic analyses revealed cortical thinning of the proximal diaphysis with new bone formation enclosing the medullary cavity. The lesion is eccentrically located involving the anterior aspect of the neck. Numerous vascular channels are apparent in the underlying bone. Sclerotic bone marks the limit of the lesion, and osseous lucency is visible in the radiograph. The individual displayed no other lytic lesions; vertebral osteophytic growth, compression fractures, and Schmorl's nodes were observed along with dental disease typical for older individuals. A traumatic etiology is eliminated due to the extensive osteolysis. Vascular, congenital, and developmental conditions are also not consistent with the observed changes. Expansive osteolytic lesions may have been caused by a cyst. Neoplastic tumors resulting in lytic lesions with a high risk of pathologic fracture are also consistent. There have been few reports of such extensive lytic lesions of the proximal femur in the paleopathological and clinical literature; this case adds an example of this underreported condition.

Climate change, human health, and resilience in the Holocene.

Climate change is an indisputable threat to human health, especially for societies already confronted with rising social inequality, political and economic uncertainty, and a cascade of concurrent environmental challenges. Archaeological data about past climate and environment provide an important source of evidence about the potential challenges humans face and the long-term outcomes of alternative short-term adaptive strategies. Evidence from well-dated archaeological human skeletons and mummified remains speaks directly to patterns of human health over time through changing circumstances. Here, we describe variation in human epidemiological patterns in the context of past rapid climate change (RCC) events and other periods of past environmental change. Case studies confirm that human communities responded to environmental changes in diverse ways depending on historical, sociocultural, and biological contingencies. Certain factors, such as social inequality and disproportionate access to resources in large, complex societies may influence the probability of major sociopolitical disruptions and reorganizations-commonly known as "collapse." This survey of Holocene human-environmental relations demonstrates how flexibility, variation, and maintenance of Indigenous knowledge can be mitigating factors in the face of environmental challenges. Although contemporary climate change is more rapid and of greater magnitude than the RCC events and other environmental changes we discuss here, these lessons from the past provide clarity about potential priorities for equitable, sustainable development and the constraints of modernity we must address.

Femoroacetabular impingement in ancient Nubia 1400-656 BC.

INTRODUCTION: There is significant recent interest in femoroacetabular impingement (FAI) in orthopaedics. The etiology of the cam deformity is unknown but has been hypothesized to be due to stresses from sporting activities in our modern society. Few archeological studies exist of femora and FAI. This study reviewed proximal femoral anatomy in a skeletal collection from the ancient Nile valley archeological site at Tombos 1400-656 BC. METHODS: Digital photographs of the femora were used to obtain angular measurements of the apparent neck shaft, true neck shaft, version, inclination, and α and ß angles of Nötzli. All photographs were reviewed by two orthopaedic surgeons for cam and pincer lesions. Sex and age of the specimens was determined when possible. A cam lesion was defined as any femur demonstrating an α angle > 50° or when a cam deformity was seen on visual inspection by both orthopaedic surgeons. Pincer lesions were identified upon visual inspection by both orthopaedic surgeons, when the femoral neck demonstrated impaction lesions, as pelvis radiographs could not be obtained. RESULTS: There were 126 unique femora; 69 female and 57 male. Age estimates were possible in 100 and was 15-24 years in 14, 25-34 years in 33, 35-49 years in 28, 50-69 years in 17, and ≥ 70 years in 8. There were nine femora (seven individuals) with cam lesions (7%) and five femora (four individuals) with pincer lesions (4%). One demonstrated a combined lesion. CONCLUSION: FAI existed in ancient Nile valley inhabitants and is thus not only a product of modern day life style athletics. This contrasts with Native Americans living in Ohio 700-1000 AD where no FAI was identified. This difference is likely due to combinations of different types of activity, diet, and genetics. Further research of ancient populations is needed to further answer this question. LEVEL OF EVIDENCE: IV-cohort study.

Twenty-first century bioarchaeology: Taking stock and moving forward.

This article presents outcomes from a Workshop entitled "Bioarchaeology: Taking Stock and Moving Forward," which was held at Arizona State University (ASU) on March 6-8, 2020. Funded by the National Science Foundation (NSF), the School of Human Evolution and Social Change (ASU), and the Center for Bioarchaeological Research (CBR, ASU), the Workshop's overall goal was to explore reasons why research proposals submitted by bioarchaeologists, both graduate students and established scholars, fared disproportionately poorly within recent NSF Anthropology Program competitions and to offer advice for increasing success. Therefore, this Workshop comprised 43 international scholars and four advanced graduate students with a history of successful grant acquisition, primarily from the United States. Ultimately, we focused on two related aims: (1) best practices for improving research designs and training and (2) evaluating topics of contemporary significance that reverberate through history and beyond as promising trajectories for bioarchaeological research. Among the former were contextual grounding, research question/hypothesis generation, statistical procedures appropriate for small samples and mixed qualitative/quantitative data, the salience of Bayesian methods, and training program content. Topical foci included ethics, social inequality, identity (including intersectionality), climate change, migration, violence, epidemic disease, adaptability/plasticity, the osteological paradox, and the developmental origins of health and disease. Given the profound changes required globally to address decolonization in the 21st century, this concern also entered many formal and informal discussions.

Two cases of skeletal dysplasia from New Kingdom (c. 1400-1050 BCE) Tombos, Sudan.

OBJECTIVE: This project investigates two cases of skeletal dysplasia from archaeological excavations of the New Kingdom Period (c. 1400-1050 BCE) portion of the Tombos cemetery in Sudan. MATERIALS: Fair to well-preserved skeletal remains of two individuals, one adult and one juvenile, are examined here. METHODS: All available skeletal elements were analyzed macroscopically. A differential diagnosis was conducted for each individual. RESULTS: The adult individual, U36.Sh2.B10, displays bilateral mesomelic dysplasia and Madelung's deformity. The juvenile individual, U36.Sh2.B5, also displays bilateral mesomelic dysplasia and characteristics associated with Madelung's deformity. CONCLUSIONS: A differential diagnosis of Léri-Weill dyschondrosteosis (LWD) is suggested for the adult female individual (U36.Sh2.B10). The second case (U36.Sh2.B5) is an approximately three to five-year-old individual and is difficult to diagnose given the young age; however, LWD remains the most likely diagnosis. SIGNIFICANCE: There are few cases of LWD in the paleopathological literature, and fewer still of juveniles. The cases described are useful examples in expanding research demonstrating the variability in the expression of skeletal dysplasias in juveniles and adults. LIMITATIONS: Taphonomic alterations and fragmentation of the crania and portions of the postcrania limited the observation of the full suite of characteristics associated with skeletal dysplasias. U36.Sh2.B5 is difficult to diagnose given the individual's young age and the possibility that this individual had not yet developed the more observable characteristics associated with these conditions. SUGGESTIONS FOR FURTHER RESEARCH: Researchers are encouraged to continue examining the range of expression of skeletal dysplasias in juveniles and adults.

A diachronic examination of biomechanical changes in skeletal remains from Tombos in ancient Nubia.

Using morphometric assessment, we diachronically analyse mechanical stress and limb function at the Tombos (modern Sudan) archaeological site through time and changing socioeconomic circumstances. Based on previous research, we expect that during the Third Intermediate/Napatan (c. 1070-656 BCE) people were larger and more physically active than in the New Kingdom (∼1400-1070 BCE). On the appendicular skeleton of adults 57 measurements were obtained on individuals from 67 discrete burials and 370 commingled skeletal elements. These raw measurements were analysed statistically. Individuals from the discrete burials were used to calculate body mass and estimate mechanical behaviour (torsional and bending rigidity of long bones) modeled using beam theory across several bones of the upper and lower limbs. Body mass estimates for both sexes show people during the Third Intermediate/Napatan period were statistically significantly larger. On the upper limb for both sexes, variation reflects joint stabilisation and actions of flexion and extension at the elbow and/or supination/pronation of the forearm. On the lower limb, females show variation related to weight bearing activities and foot flexion; male variation is related to weight bearing activities, joint movement and stabilisation. These data point to altered habitual behaviour and physical activity for both sexes at Tombos through time. Suggested causes for both sexes include increased agricultural activities, and for males increased granite quarrying and equestrian activities. Using analyses of multiple bones of the upper and lower limbs in conjunction with biomechanical analyses, this study demonstrates the importance of the examination of physical activities in past populations, highlighting changes that can occur with sociopolitical transitions.

Tombos during the Napatan period (∼750-660 BC): Exploring the consequences of sociopolitical transitions in ancient Nubia.

This study examines the consequences of the sociopolitical transition in the Nile Valley from New Kingdom Egyptian control (18-20th Dynasties of Egypt, ∼1550-1069 BC) to Napatan Nubian rule (25th Dynasty of Egypt, ∼750-660 BC) through the analysis of skeletal remains and mortuary ritual at the site of Tombos in Upper Nubia (modern Sudan). Demographic variables as well as indicators of nutritional deficiency and infectious disease (linear enamel hypoplasia, cribra orbitalia, osteoperiostitis, and femur length) are used to assess the effects of governmental changes on people living in Nubia during these periods. It is evident from the skeletal sample that the Egyptian-Nubian community at Tombos continued to thrive after the fall of the New Kingdom Egyptian empire. Drastic differences in linear enamel hypoplasia and osteoperiostitis are not apparent in the New Kingdom and Napatan components at Tombos. However, an increased level of remodeled cribra orbitalia along with greater average femur length in the Napatan female cohort indicates better recovery from times of nutritional and infectious conditions in comparison with the New Kingdom individuals. Variable circumstances experienced by New Kingdom Egyptian colonists at Tombos, as well as genetic differences, may account for the observed frequencies of these paleopathological indicators.

Strontium isotope (87Sr/86Sr) variability in the Nile Valley: identifying residential mobility during ancient Egyptian and Nubian sociopolitical changes in the New Kingdom and Napatan periods.

As a successful technique for identifying residential mobility in other areas, this study investigates the feasibility of using 87Sr/86Sr analysis to track the movements of the ancient peoples of Egypt and Nubia in the Nile Valley, who interacted via trade, warfare, and political occupations over millennia. Dental enamel from faunal remains is used to examine variability in strontium sources in seven regional sites; human enamel samples are analyzed from eight Nile Valley sites in order to trace human movements. The faunal samples show a wide range of 87Sr/86Sr values demonstrating that some animals were raised in a variety of locales. The results of the human samples reveal overlap in 87Sr/86Sr values between Egyptian and Nubian sites; however, Egyptian 87Sr/86Sr values (mean/median [0.70777], sd [0.00027]) are statistically higher than the Nubian 87Sr/86Sr values (mean [0.70762], median [0.70757], sd [0.00036], suggesting that it is possible to identify if immigrant Egyptians were present at Nubian sites. Samples examined from the site of Tombos provide important information regarding the sociopolitical activities during the New Kingdom and Napatan periods. Based on a newly established local 87Sr/86Sr range, human values, and bioarchaeological evidence, this study confirms the preliminary idea that immigrants, likely from Egypt, were present during the Egyptian New Kingdom occupation of Nubia. In the subsequent Napatan period when Nubia ruled Egypt as the 25th Dynasty, 87Sr/86Sr values are statistically different from the New Kingdom component and indicate that only locals were present at Tombos during this developmental time.

Investigating health at Kerma: sacrificial versus nonsacrificial individuals.

This analysis examines heterogeneity in risks by assessing the health status of individuals in two distinct burial contexts from the Nubian site of Kerma: sacrificial (n = 100) and nonsacrificial (n = 190) burial areas dated to the classic Kerma period ( approximately 1750-1500 BC). Indicators of physiological stress that were examined include cribra orbitalia, dental enamel hypoplasia, tibial osteoperiostitis, and femur length. The analysis presented here shows that the people interred in the sacrificial and nonsacrificial burial contexts at Kerma in Upper Nubia had similar health profiles that were comparable with other contemporaneous samples from the region. If sacrificial individuals did not experience the same risk of death as nonsacrificial individuals, it was not evident in the frequencies of nonspecific stress indicators. However, this differential risk of death may be blurred by our inability to examine nonadults for childhood disease. This research demonstrates the complexities involved in understanding the multiple factors that result in heterogeneity in skeletal samples.

Traumatic injuries and imperialism: the effects of Egyptian colonial strategies at Tombos in upper Nubia.

As circumstances of conquest change, leaders of empires must adapt their colonial strategies in order to be successful. One example of such modification in approach is the shift from Middle Kingdom to New Kingdom Egyptian colonial activities in Nubia. During the Middle Kingdom (2050-1650 BC) Egypt used aggressive military campaigns to subdue the strong Nubian polity at Kerma, resulting in the construction of fortresses and many victory stelae. In the subsequent New Kingdom period (1550-1050 BC) during which the Egyptian administration succeeded in occupying nearly all of Nubia, changes were necessary in conquest strategies. Diplomacy and cooperation may have replaced military action as mechanisms of control. This article investigates changes in imperial policy through the examination of traumatic injuries in human skeletal remains. Patterns of injuries in a sample from the site of Tombos, an Egyptian colonial cemetery in Nubia dating to the New Kingdom period, are compared with data on the patterns of injuries from Kerma, a cemetery dating to the Middle Kingdom period, published by Judd (2004). Analysis indicates a decrease in the level of traumatic injuries from Kerma to Tombos supporting the idea that through time the Egyptian administration modified their colonial strategy toward more nonviolent means. This article presents data on differences in the patterns of injury at Tombos and Kerma and explores possible explanations for this variation.

Health of the non-elites at Tombos: Nutritional and disease stress in New Kingdom Nubia.

During the New Kingdom period, Egypt succeeded in occupying most of Nubia. Colonial towns were built, which served as centers of government and redistribution. This paper uses a bioarchaeological approach to address the effects of this cultural contact on non-elites. Skeletal remains from the site of Tombos (N = 100), a cemetery in Upper Nubia dating to this important time, are analyzed, in addition to 1,082 individuals from contemporaneous Egyptian and Nubian sites, in order to shed light on the social, political, and economic processes at play and to determine how the people at Tombos were affected during this transitional period. In many ways, the Tombos population appears to have been affected by similar stressors as the other populations under study. However, a few small differences in the subadult frequencies of pathological lesions, especially remodeling rates, are significant in the overall picture of health at Tombos. These analyses suggest that, although the people of Tombos may have been integrated into the Egyptian colonial network, the additional resources they may have obtained could not protect them from nutritional and disease stress. A lower childhood survival through bouts of ill health at Tombos is suggested. While status may have played a role in the differences seen in the comparative populations, it is likely that parasites and/or other infections led to childhood illness and death.