Scapular stress fracture: a palaeopathological case consistent with crutch use

Abstract

This report describes a defect on the right scapula of a 50 to 60 year old male slave who had been buried extra-muros in the Le Colombier cemetery of Vaison-la-Romaine (5 th to 6 th century AD) in Vaucluse, France. This injury can only be described as a stress fracture, most likely associated with heavy and persistent use of the humerus in abduction. Other bony defects on the skeleton included early signs of ossification of the glenohumeral joint, slight vertebral discopathy, and osteoarthrosis on the right hip. A relationship between scapular stress fractures and walking devices has been described in the current medical literature, and taking this in consideration, possible aetiologies for this scapular defect include either consistent use of a crutch or routine physical labour. Little information is available on either stress fractures or assisted walking devices in antiquity; therefore this information is a valuable contribution to palaeopathology.

Commentary: Pathological fractures in osteomalacia, an underrecognized phenomenon

“…When the case from Vaison‐la‐Romaine, Vaucluse, France was submitted for publication (November 2007), limited information was available on osteomalacic lesions in paleopathology. The grave of the individual discussed was located at the edge of the Le Colombier cemetery (5th–6th CE) situated outside the city walls, a position suggesting that the remains were those of an enslaved individual (Darton, 2010). The focus of the paper was a lesion on the right scapula.…”

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“A transverse cleft was noted on the posterior side of the scapula, which measured 13mm in length from the lateral scapular border. The defect was found within an osteoplastic roll that had fine, irregular and brittle edges” (Darton, 2010, p. 114; see Figure 1).

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“…Illustrations from Darton (2010). (a) The right scapula with the left‐hand arrow marking the cleft (pseudofracture) reported in the original publication.…”

“…The original caption mentions this lesion occurs in an area of reduced density referred to as an osteoporotic area. Reproduced with permission John Wiley and Sons from Darton (2010). Scapular stress fracture: a palaeopathological case consistent with crutch use.…”

Approach to disability in a population from the Argar Culture

“…Moreover, any evidence that an individual was cared for does not reveal the attitudes or rationale underlying this treatment (Finlay 1999;Tarlow 2000). There are further reports on individuals with physical impairment in recent Prehistory and even more in Classical Antiquity and Mediaeval times, and the diffi culty in all cases is to determine how they were considered in their societies (Buquet-Marcon et al 2009;Darton 2010;Dickel and Doran, 1989;Hawkey 1998;Lieverse et al 2008;Oxenham et al 2009;Pany and Tescher-Nicola 2007;Phillips and Sivilich 2006;Van der Sanden 1996). Palaeopathology studies can offer biological evidence of physical impairment but cannot provide direct evidence of disability, i.e., the relationship between impaired individuals and their societies (Shakespeare 1999).…”