Article

Considering care: A traumatic obturator fracture dislocation of the hip in a middle-aged man from Gaelic Medieval Ballyhanna, Co. Donegal, Ireland

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Abstract

Objective This article explores the potential care provided to a middle-aged man who had a suite of injuries evident in his skeleton, most notably an obturator fracture dislocation in his left hip. Materials The skeleton derived from the Late Medieval Gaelic population buried at Ballyhanna, Co. Donegal, Ireland. Methods A transdisciplinary bioarchaeology of care approach was adopted to undertake a phenomenological study of an individual with an acquired disability. Results The man would have required intensive nursing care in the months following the initial injury, and longer-term accommodations may have been made by the wider community to support him. Conclusions Use of a transdisciplinary bioarchaeology of care approach enables important insights to be gained concerning the social impact of disability on the affected individual, his kin, and wider community. Significance This study achieves a new level of integration of bioarchaeological findings with archaeological, historical, and ethno-historical sources, thereby enabling a phenomenological approach to interpretation of life after acquired disability. This is the first study to allow such an intimate insight into lived experience and it provides a model for bioarchaeology of care analysis of individuals from historical eras. Limitations These include difficulties in identifying the nature of a long-standing complex injury. Suggestions for future research Further explorations of the bioarchaeology of care in historical time periods should incorporate a similarly wide range of transdisciplinary sources to enrich interpretations of the lived experiences of individuals, their care-givers and broader communities.

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... Te next cases are from the 2 nd millennium CE. McKenzie et al. [47] signifcant care after healing, as this injury markedly inhibits mobility and is very disabling. Such prolonged bed rest would typically result in an early demise due to all the same complications that occur with bed rest treatment of adult hip fractures, which did not occur in this case. ...
... Tere must have been considerable care aforded to such an individual to minimize the morbidities associated with nonoperative care of such a fracture. Tis has been recently noted in a medieval case of an obturator fracture dislocation of the hip [47] as well as other fractures [54] from the medieval period. Dittmar et al. [54] described three individuals from medieval Cambridge, England, with multiple fractures. ...
... As there were amulets, fgurines, beads, and vessels in this burial, the individual was likely from a high socioeconomic position having the resources to provide such intense care. Tis is similar to the case described earlier by McKenzie et al. [47]. As there were no degenerative changes in this individual in the foot/ankle, indicating that the fractures occurred relatively recently, they also thus occurred when the individual was osteopenic as seen from the bone density analyses. ...
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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.
... In the fifth case study, McKenzie et al. (2022) use the bioarchaeology of care approach to recreate the experience of a middle-aged man from Late Medieval Ireland (13th -late 16th c. CE) who suffered several injuries, the most serious requiring dedicated nursing in the short-to-medium term and minimally 'accommodation' up until death. ...
... Several papers illustrate the benefits accruing from the use of increasingly sophisticated imaging technologies and associated analytical techniques for identifying the nature and clinical impacts of pathology with greater precision; this precision underpins a more refined assessment of the individual's need for, and receipt of, care (in particular, see Bédécarrats et al., 2021;Bethard et al., 2021;Dittmar et al., 2023;Miclon et al., 2021). Most authors reference relevant contemporary texts (even if briefly) where these are available, but in some papers these sources are central to content (e.g., Cilione and Gazzaniga, 2023;Kozakaitė et al., 2022a, b;Robb et al., 2021); in three instances (Fedorina et al., 2022;Knüsel, 2021;McKenzie et al., 2022), folkloric, ethnographic and ethnohistoric sources -often overlooked in bioarchaeological reportsenrich interpretation significantly. Many papers challenge (sometimes overturn) assumptions about aspects of health, disease and care practices and/or social attitudes in relation to disability in medieval times (e.g., Bédécarrats et al., 2021;Miclon et al., 2021;Robb et al., 2021;Tilley and Cave, 2023), demonstrating that a bioarchaeological lens can offer new perspectives on a past we believe is 'known'. ...
... Many papers challenge (sometimes overturn) assumptions about aspects of health, disease and care practices and/or social attitudes in relation to disability in medieval times (e.g., Bédécarrats et al., 2021;Miclon et al., 2021;Robb et al., 2021;Tilley and Cave, 2023), demonstrating that a bioarchaeological lens can offer new perspectives on a past we believe is 'known'. Finally, a number of the case studies highlight the importance of (re)considering medieval attitudes towards those experiencing disability, with findings indicating a lack of stigmatisation and an acceptance of difference which support the observations of some medieval historians (e.g., Metzler, 2006;Cilione and Gazzaniga, 2023) and add a touch of humanity to our understanding of life in this era (e.g., Bethard et al., 2021;Kozakaitė et al., 2022b;McKenzie et al., 2022;Tilley and Cave, 2023). ...
... Developments of further biomechanical complications such as secondary DJD (i.e., coxarthrosis) in later life could only have exacerbated such situations. Although we cannot evaluate the psyche of the deceased, having a limited capacity to physically participate in society could have had a profound effect on the individual's mental well-being (McKenzie, Murphy, and Watt 2022). For instance, chronic pain, restriction of movement, and being unable to carry out physical functions could have all led the individual to feel self-burdening (Cassileth et al. 1984;Moussavi et al. 2007). ...
... Extrapolating clinical data to the past is ubiquitous for paleopathologists (Grauer 2019) and has not inhibited other paleopathological studies from contextualizing other individuals who have also suffered from LCPD and other diseases in the past (Herrerín and Garralda 2012;Buckberry et al. 2014;McKenzie, Murphy, and Watt 2022). ...
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Neglected dislocations of the hip are uncommon and open reduction is usually followed by avascular necrosis and subsequent coxarthrosis. We present a rare case of neglected, locked, obturator type of inferior hip dislocation in a young adult presenting 6 months after initial trauma treated with a cementless total hip arthroplasty which, to the best of our knowledge, has not been reported previously. Technical aspects of total hip arthroplasty and other treatment options in this scenario are discussed.
Article
The objective of our literature review was to inform orthopaedic nurses about the complications of clavicular fracture, which are easily misdiagnosed. For this purpose, we searched MEDLINE (1965-2005) using the key words clavicle, fracture, and complications. Fractures of the clavicle are usually thought to be easily managed by symptomatic treatment in a broad arm sling. However, it is well recognized that not all clavicular fractures have a good outcome. Displaced or comminuted clavicle fractures are associated with complications such as subclavian vessels injury, hemopneumothorax, brachial plexus paresis, nonunion, malunion, posttraumatic arthritis, refracture, and other complications related to osteosynthesis. Herein, we describe what the orthopaedic nurse should know about the complications of clavicular fractures.
Article
Undisplaced fractures of both the diaphysis and the lateral end of the clavicle have a high rate of union, and the functional outcomes are good after nonoperative treatment. Nonoperative treatment of displaced shaft fractures may be associated with a higher rate of nonunion and functional deficits than previously reported. However, it remains difficult to predict which patients will have these complications. Since a satisfactory functional outcome may be obtained after operative treatment of a clavicular nonunion or malunion, there is currently considerable debate about the benefits of primary operative treatment of these injuries. Displaced lateral-end fractures have a higher risk of nonunion after nonoperative treatment than do shaft fractures. However, nonunion is difficult to predict and may be asymptomatic in elderly individuals. The results of operative treatment are more unpredictable than they are for shaft fractures.
Article
Professional experience and lay wisdom teach us the benefits of exercise and the hazards of idleness. Yet the myth persists that "bed rest is good for you" when ill or convalescing. Abundant scientific evidence in the past 50 years has demonstrated the specific damage done to each of the body's organ systems by inactivity. Both aging and inactivity lead to strikingly similar kinds of deterioration. I summarize the data from military and veterans' hospitals, rehabilitation experience, aerospace research, and gerontology and review the physiologic and metabolic changes of aging and inactivity, along with strategies to help prevent the iatrogenic complications of bed rest.
Article
Prolonged bed rest causes major cardiovascular, respiratory, musculoskeletal, and neuropsychological changes. Complications often result from these effects of bed rest, especially when aging has already decreased the reserves in these systems. These problems can be limited by judicious prescription of modified bed rest.
Article
Farming is among the three most hazardous occupations in modern society and perhaps also held a similar position during the medieval period. The goal of this study was to determine if there is a significant difference in frequencies and patterns of longbone fracture trauma observed between rural and urban activity bases that distinguish farming as a particularly dangerous occupation during the medieval period. The longbones of 170 individuals excavated from Raunds, a rural medieval British site (10th-12th centuries AD) were examined for fractures and compared to data collected from four contemporary British medieval sites, one rural and three urban. The fracture frequency for the Raunds individuals (19.4%) was significantly different from the urban sites (4.7-5.5%). Female fractures were characterized by injury to the forearm, while the males were predisposed to diverse fracture locations. Clinical research provided a source of documented farm-related trauma from North America and Europe where the crops and animals raised, the manual chores performed, and the equipment used in traditional or small-scale farms have changed little in form or function since the medieval period. Nonmechanized causes of injury contribute to approximately 40% of all modern farm-related injuries and are attributed to falls from lofts and ladders, animal assaults and bites, and falls from moving vehicles. These hazardous situations were also present in the medieval period and may explain some of the fracture trauma from the rural sites. A high fracture frequency for both medieval males and females is significantly associated with farming subsistence when compared to craft-orientated urban dwellers.
Article
An epidemiologic study of 535 isolated clavicle fractures treated in a hospital of a large metropolis during an 11-year period was performed. Data regarding patient's age and sex, side involved, mechanism of injury, and season in which the fracture occurred were obtained from the clinical records. Radiographic classification was performed with the Allman system. Clavicle fractures represented 2.6% of all fractures and 44% of those in the shoulder girdle. Most patients were men (68%), and the left side was involved in 61% of cases. Fractures of the middle third of the clavicle, which were the most common (81%), were displaced in 48% of cases and comminuted in 19%. Fractures of the medial third were the least common (2%). The prevalence of midclavicular fractures was found to decrease progressively with age, starting from the first decade of life when they represented 88.2% of all clavicle fractures and were undisplaced in 55.5% of cases. In adults, the incidence of displaced fractures, independent of location, was higher than that of undisplaced fractures. Traffic accidents were the most common cause of the injury. In the period under study, the incidence of fractures showed no significant change over time and no seasonal variation.
Archaeological excavations at Ballyhanna graveyard – chronology, development and context
  • Macdonald
Life and Death in Medieval Gaelic Ireland: The Skeletons from Ballyhanna
  • C J Mckenzie
  • E M Murphy
The Science of a LostMedieval Gaelic Graveyard - The Ballyhanna Research Project (TII Heritage 2)
  • C J Mckenzie
  • E M Murphy
  • C J Donnelly
The holy wells of Donegal
  • Muirgheasa, E
Irish Ethnobotany and the Evolution of Medicine in
  • M Moloney
Gaelic and Gaelicized Ireland in the Middle Ages
  • K W Nicholls