Trauma and treatment in the British Isles in the Historic Period • 237 



Figure \0(left). Measurement of 

 amount of overlap of fracture 

 fragments in a fibula fracture of 

 a Medieval individual from Bil- 

 lingsgate cemetery, London. 



Figure 1 1 (right). Soil in the 

 medullary cavity of a fibula 

 obscuring a fracture in proximal 

 shaft. 



measured roughly. The relationship of the ends of the fracture 

 fragments to each other was also recorded (Figure 9). Muscu- 

 lar contraction at the time of injury can make reduction of 

 fractures problematical, and this would have been particular- 

 ly so in ancient populations. 



OVERLAP. The amount of overlap of the fracture fragments 

 and degree of apposition could also be measured on the x-ray 

 by direct measurement (Figured). Overlap of fragments may 

 mean (for example in a tibial fracture) a shortened leg for the 

 individual and difficulties with mobility. One-third to one- 

 half apposition of the broken fragments in a fracture is be- 

 lieved to give a good functional result in modem populations 

 (Figure 10). 



X-RAY analysis: PROBLEMS 



Several problems were inherent in examining x-ray films, 

 mostly generated by the fact that archeological populations 

 have been buried in the ground, unlike their modem counter- 

 parts. Soil in the medullary cavity of long bones made detec- 

 tion of the original fracture line ditTicult (Figure 1 1) even 

 though, macroscopically, there was evidence of a fracture. A 



Zagreb Paleopathology Symp. 1988 



fracture could also be misdiagnosed by the appearance of 

 vascular channels in the bone shaft. Fractures of very long 

 standing were often so well healed that the original type of 

 fracture was not identified. 



On the x-ray in the callus there were often flecks of radio- 

 dense soil particles mimicking calcified healed areas to the 

 untrained eye. Alternatively, radiolucent areas around the 

 fracture site could be mistaken for infective lesions, but 

 the main difficulty was to determine whether the radiolucent 

 area was ante or post mortem. 



Pathological fractures were often difficult to identify, es- 

 pecially in the case of osteoporosis underlying the fracture. 

 Osteoporosis is a very common condition today, especially in 

 older women where the quality of the bone remains constant 

 but the quantity decreases. This is particularly seen in ribs, 

 vertebrae and the pelvis. The osteoblast and osteoclast bal- 

 ance is lost and the bone is liable to break under minimal 

 force. However, diagenetic factors working on skeletons in 

 the ground in cemetery sites may make the bone appear to be 

 osteoporotic. The main problems are whether the individual 

 had osteoporosis before the fracture, after the fracture, or 

 whether it developed because of bed rest (disuse osteo- 

 porosis) or as a postdepositional syndrome. 



