Proximal femur fractures among a medieval Christian population of northern Sudan: prevalence and aetiology

Abstract

AbstractThe current paper investigates the prevalence and aetiology of proximal femur fractures in two temporally distinctive groups of medieval Christian Nubia: the monastic community (ca. late 7th to half of 13th c. AD) and a later group of post‐monastic, intrusive interments (ca. 13th c. AD) from Cemetery 2 at Ghazali, northern Sudan. Four cases of proximal femur fractures were identified macroscopically among the skeletal remains of 86 adult individuals and subjected to detailed investigation of underlying aetiology due to the unusual demographic characteristics of the individuals. The proximal femora were subjected to radiographic examination and classification of trauma using the AO/Orthopaedic Trauma Association (OTA) system, and the prevalence of fractures was calculated. Among the 77 adult individuals examined from the Monastic Phase of Cemetery 2, three cases of hip fractures were identified, a prevalence of 3.9%, whereas only one was identified among the nine post‐monastic individuals, which accounts for 11.1% of the total sample. All of the recognized fractures belong to the extracapsular type. Analysis of the mechanisms of fracture in the four studied individuals from Ghazali, despite the relatively young age of male individuals, does not exclude osteoporotic background resulting in stress‐induced fragility trauma. Considering the demographic profile of the deceased and observed comorbidities, it is concluded that sustained fractures were the result of high‐impact injuries connected with demanding physical activity in the harsh Bayuda desert environment.