Paleoepidemiology of trauma in a prehistoric California population • 243 



Figure 2. Ununited fracture of right 

 radius. Male, 35-50 years. 



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The second case, also a male (35-50 years of age), dis- 

 plays an ununited fracture of the distal right radius. Most of 

 the radius is missing, but the distal piece that is present has a 

 completely sealed marrow cavity. In addition, another small 

 piece, representing the middle third of the diaphysis, also has 

 a sealed marrow cavity (Figure 2). The right ulna is also 

 fractured at approximately the same location, but shows 

 good healing with a slight, angular deformity. 



The third case of nonunion is a probable female, aged 21- 

 30, with an ununited fracture of the left ulna 1 1 1 mm below 

 the proximal end. The marrow cavity is again sealed and 

 there is evidence of fibrous union with extreme hypertrophic 

 reaction particularly in the area of attachment of the pronator 

 quadratus. The distal piece, however, is missing. The radius 

 is uninvolved. 



The final case of nonunion is seen in the right ulna of a 

 male, aged at more than 40 years at death. The lesion occurs 

 73.9 mm below the proximal end, and both ends are sealed 

 with fibrous union. However, the bone still appears highly 

 reactive (vascularized), and there is secondary degenerative 

 disease of the wrist. 



As seen, all cases of nonunion are of the forearm, as is 

 consistently the pattern in other reports of this type of lesion. 

 All the elements described by Stewart are also in the forearm, 

 although he does mention cases involving the clavicle and 

 femoral neck. Likewise, the only involved element at Libben 

 is also a forearm bone (an ulna). However, it must also be 

 noted that, as a result of poor recognition and diagnosis, this 

 type of lesion may be considerably underrepresented in the 

 paleopathological literature. Indeed, in di.scussion at the 

 symposium and subsequent communication, several other 

 cases of ununited fractures were noted: four from the Win- 

 dover site in Florida (Dickel, pers. comm.) and two ca.ses 

 from archaic populations of the Great Lakes region of North 

 America (Pfeiffer 1985, pers. comm.). 



Other than the forearm, fractures in general are very rare in 

 this population. Only eight other definite fractures of long 

 bones are seen (two clavicles, one humerus, and five tibias). 

 It must be emphasized that, as noted above, even with radi- 

 ographic analysis, diagnosis of well-healed fractures is often 

 impossible. 



Fracture rates are difficult to compare between popula- 

 tions, as often the frequencies are not computed by individual 

 elements, and even where they are, the degree of complete- 

 ness of the sample is not taken into account. Among the 

 better paleoepidemiological approaches to the study of frac- 

 ture incidence is Lovejoy and Heiple's work with the Libben 



Zagreb Paleopathology Symp. I98S 



Figure 3. Fused right hand elements; all carpals and 2d and 

 3d metacarpals. Female, 39-44 years. 



population. In order to control foreffect of preservation, only 

 intact long bones were included and carefully tabulated. A 

 similar methodology is used here. The overall fracture inci- 

 dence at Libben was 72/2383 (3.0%) compared to 36/2047 

 (1.8%), that is, only about half as high in this study. In 

 addition to the clear quantitative difference in frequency, the 

 pattern of involvement also varies dramatically. At Libben, 

 the most frequently fractured element was the clavicle, in- 

 volved in 15/260 cases (5.8%). At Ala-329, however, only 

 two definite clavicular fractures are found in 291 intact ele- 

 ments (less than 1%). Certainly, in modem groups, most 

 clavicular fractures result from severe falls (or auto acci- 

 dents). The frequency of bad falls at Ala-329 thus appears to 

 have been lower than at Libben. Indeed, Lovejoy and Heiple 

 (1981) state that from modem U.S. data the clavicle is the 

 most fractured long bone. 



A particularly dramatic case at Ala-329 that did result from 

 a severe fall is a 39-44-year-old female who had an apparent 

 fracture to the distal right ulna (or Allen's fracture) that also 

 severely traumatized the hand. Indeed, all the carpals plus 

 the 2d and 3d metacarpals are fused into a solid block (Figure 

 3). In addition, the left arm is also broken (distal left radius), 

 all perhaps as a result of one very serious fall. 



Therefore, it would seem a different fracture pattem is 

 indicated at Ala-329 compared to that at Libben. At Ala-329, 

 severe falls were not the single primary cause of fracture. The 

 relative infrequency of Colles' and Allen's fractures, seen in 

 only II cases (5 Colics'. 6 Allen's), further suggests this. 

 Another possible explanation for the lower frequency of frac- 

 tures seen in the Califomian population could be demograph- 

 ic. Lovejoy and Heiple (1981) make the explicit point that 

 fracture risk is directly linked to longevity. And, indeed, 

 older individuals in both samples have more healed fractures. 



