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al 2006 118 although these early plates suffered from corrosion problems it soon became apparent that internal plate fixation could provide a safe and efficient way for patients to heal whilst also regaining some form of movement various plate designs improved on earlier designs allowing for micromotion at the fracture site and compensation for bone resorption during the healing process uhthoff et al 2006 124 contend that there are still problems in the form of internal plates where compression and stress shielding can still lead to bone necrosis and cortical porosis in their conclusion they argue that there still needs to be a fine balance attained between a plate design that managed to reduce stress shielding and allows adequate micromotion at the site of a fracture both which they concur would help mimic biological healing there also drawbacks that can include plate palpability risk of infection temperature sensitivity and possible growth restriction with metallic implants bali et al 2013 167 ultimately however the body still has to heal the fracture itself over a matter of weeks and months white folkens 2005 48 it is interesting to note that sir william lane himself writing in the late 19th century and primarily focusing on lower limb fractures indicates the marked differences between upper and lower limb fracture treatment he states that although the upper limb does not take the weight of the body in the arm very considerable alterations may occasionally develop and are more marked and depreciating to the value of the individual as a machine in proportion as changes have already taken place in the particular joint or joints from the prolonged pursuit of a laborious occupation lane 1895 861 deciding that fractures of upper limb need not be set directly in their original anatomical form whereas lower limb bones should be set as close to as originally constituted due to their weight bearing nature furthering this view in the same letter to the british medical journal in 1895 he highlights that one cannot but feel that the perpetuation of methods of treatment which have been in use up to the present time must depend on the fact that surgeons have not taken such trouble to inquire into the subsequent life history of these patients as they have done in other departments of surgery lane 1895 863 there have been some distinct advances in using biodegradable plates in non weight bearing locations such as in the maxillofacial region a position where many would like to avoid the intrusive nature of a temporary or permanent metal plate a study by bali et al 2013 167 has highlighted the value of using biodegradable material to help fixate trauma induced facial fractures reporting that each individual in the small study cohort n 10 of varying ages reported good reduction of fracture and evidence for the total biodegradation of the plate after two years they also reported that no further surgical procedures were needed on their test cohort a significant finding as metallic implants often either need removing if they are temporary or debriding if they become infected both quite serious surgical procedures bali et al 2013 170 unfortunately the study highlights that biodegradable implants are unlikely to be currently safe to use in weight bearing or load bearing bones bali et al 2013 171 conclude by stating that further studies are needed but biodegradable plates and screws can provide satisfactory if expensive stabilization as internal fixations for mid face fractures medical science and engineering has certainly come a long way since lane first introduced the internal fixation plate yet humans are as prone as ever to fracturing their bones as a person with mccune albright syndrome i may know the pain of breaking a bone but i can be thankful that i live at a time and in a place where fractures can be confidently treated further information i ve written in more detail on polyostotic fibrous dysplasia and mccune albright syndrome here which details the way in the which the disease has affected my skeleton also on that particular post are a host of medical palaeopathology and osteology related articles to do with mccune albright syndrome and fibrous dysplasia in general alternatively search the blog for the keywords and numerous posts in which i ve highlighted the syndrome and the bone disease will appear a previous post on 3d printing in orthopaedic surgery can be found here and an entry giving a quick overview of some of the problems and approaches used in studying physical impairment and disability in archaeological contexts can be found here bibliography bali r k sharma p jindal s gaba s 2013 to evaluate the efficacy of biodegradable plating system for fixation of maxillofacial fractures a prospective study national journal of maxillofacial surgery 4 2 167 172 open access digitised diseases 2014 master record number 0365 accessed 18 08 14 http www digitiseddiseases org viewer viewer_overlay php mrn 0365 lane w a 1895 some remarks on the treatment of fractures british medical journal 1 1790 861 863 open access marsland d kapoor s 2008 rheumatology and orthopaedics crash course 2nd edition london mosby elsevier meyers k 2012 break a leg fracture treatment in iron age and roman britain bones don t lie accessed 11th august 2014 open access oakley a 2007 fracture adventures of a broken body bristol policy press uhthoff h k poitras p backmann d s 2006 internal plate fixation of fractures short history and recent developments journal of orthopaedic science 11 2 118 126 open access white t d folkens p 2005 the human bone manual london elsevier academic press tags bone fractures fractures history of fracture treatment human osteology medical history personal personal trauma trauma comments 1 comment categories bioarchaeology bone disease digitised diseases digitised diseases model fibrous dysplasia fracture fracture fixation fracture treatment human osteology mccune albright syndrome medical history orthopaedics palaeopathology pathology personal reflection polyostotic fibrous dysplasia university of bradford x ray pain briefly 17 jun just a quick note here i had the good luck of hearing historian joanna bourke on bbc radio 4 program start the week yesterday morning who was on the show debating the topic of her latest publication titled the story of pain from prayer to painkillers the book focuses on trying to understand and contextualise the feeling of bodily and physical pain from the 18th century ad to the modern period bourke who is a professor of history at birkbeck university of london presents a holistic history of understanding pain in which the topic is approached from numerous angles including not just the medical but also the cultural religious and political the book also deals with the personal experience of pain and the nature of suffering both in the individual sense and within wider society from the family out it certainly looks like an interesting and enlightening read having read a few reviews of the book itself and of having heard bourke herself discuss the differences in understanding the many types of pain it reminded of sociologists ann oakley s 2007 book fracture of which i discussed a little here although oakley s book is a much more personal and reflective study with its focus on the modern health perspective bourke 2014 also discusses the role and changes that medicine has gone through in the past and present approaches and treatments when considering illnesses and patients themselves of particular interest on the radio show this morning was bourke s assertion that different cultures experience pain in a myriad of ways this of course made me think of how bioarchaeologists approach the archaeological record and how we try to understand palaeopathology in relation to the individual osteobiographic context within the population and society that the person lived in together the original context of the landscape environment of the archaeology site read more about osteobiographical examples here bioarchaeology is as a field a burgeoning area of archaeological research one that ably and actively straddles the humanities and science divide with ease bioarchaeologists often complement their normal macro and micro assessment of the skeletal remains with the regular use of the latest scientific techniques and refinements including but not limited to stable isotopic and ancient dna analysis to help understand the processes implications and contexts of a pathology within a population this often includes trying to contextualise and understand traumatic or congenital pathologies that can be present in the skeletal remains of humans white folkens 2005 it must be remembered of course that only a small fraction of diseases known ever affect or actively present on bone itself waldron 2009 pain though is rarely considered when describing a pathology that is present on an archaeological bone this is partly due to the nature of the limitations of archaeology but also partly due to the existing bioarchaeological literature care to not exceed the evidence must take precedence otherwise bioarchaeologists risk inflating the boundaries between the known and the unknown pain itself is a uniquely personal feeling and it can be a difficult feeling to describe it can also be paradoxical as to know pain is to be reminded that you are alive but to know that pain means it is also a warning that life is threatened as a purely personal perspective i have recently found out something rather interesting about my own skeletal biology as readers of this blog may be aware that i have mccune albright syndrome mas and as a part of this polyostotic fibrous dysplasia mas is as far as it is currently possible to tell a fairly rare bone disease that can lead to fractures and bowing of the bones more information here and also dumetriscu collins 2008 amongst other things having broken a good number of the long bones of my body i am now acutely aware of what a fracture feels like recently however and completely unbeknownst to myself beforehand i learnt that i have been fracturing my ribs for a number of years as both x rays and a ct scan showed a fair amount of bone re modelling and faint healed fracture lines on a number of ribs why hadn t i noticed partly it was because the fractures themselves weren t that painful i am well aware that rib fractures are usually pretty painful in fact i have been aware for years that i occasionally pull the superficial or intercostal rib muscles on either side periodically and that this had always led to a good few days of unease if i slept on the affected side coughed or laughed too hard i had put this down to using the wheelchair more over an extended period of time starting from my mid adolescence following on from several major surgeries on the femora i reasoned that due to repetitive nature of the motion of wheeling in a manual wheelchair the muscles were bound to get sore and fatigued at some points a copy of the posterior to anterior x ray of my own chest although the healed rib bruises and fractures cannot clearly be seen on it the constriction of the chest wall is highlighted black arrows this can have an effect on the air intake of the lung capacity generally fractured ribs are left to heal naturally unless there has been puncturing of internal organs by the ribs themselves in which cases surgery is needed read more here i was well aware that the ribs are one of the more common areas of the body to be affected by mas along with the femora and cranial bones yet i paid little attention to what i thought was a pulled muscle dumetriscu collins 2008 waldron 2009 i could still move relatively fine afterwards and it certainly wasn t that painful so as you can imagine i was somewhat surprised to hear that i had at least four previous rib fractures that had healed which were clearly evident on the x rays and the scans taken of my chest as i saw i should state though that it is likely to have been a mix of micro hairline and full fractures on pathologically diseased bone and not traumatically induced fractures which i hear can be extremely painful as such and having heard bourke talk about how individuals cope with pain it should be taken into account by bioarchaeologists that skeletal pathology probably elicited different responses dependent on the social and cultural context of the individual this is of course important when considering the impact of a pathology present on the bones this necessarily becomes more problematic as we reach further into history and prehistory where the lack of contextual and written evidence can be missing or non existent however as archaeologist and bioarchaeologists we must also continually ask questions regardless and especially when skeletal material has already been analysed new techniques theories or methodologies are only useful once they have been applied to the existing archaeological record and are repeatedly tested against what we think we know alongside bourke on the radio 4 show was the current director of the wellcome trus t jeremy farrar who discussed his experiences as a medical doctor and the possible implications of the overuse antibiotics and norman fowler a conservative mp who oversaw the public health campaign against the spread and threat of hiv aids in the 1980 s in britain each guest on the program was well worth a listen it is safe to say that bourke s work is another book that i shall be adding to my ever increasing pile further information listen to the start the week program on which professor bourke appeared on bbc radio 4 here a review by the guardian of the history of pain from prayers to painkillers book be found here bibliography bourke j 2014 the history of pain from prayer to painkillers oxford oxford university press dumitrescu c e collins m t 2008 overview mccune albright syndrome orphanet journal of rare disease 3 12 1 12 open access oakley a 2007 fracture adventures of a broken body bristol policy press waldron t 2009 palaeopathology cambridge manuals in archaeology cambridge cambridge university press white t d folkens p 2005 the human bone manual london elsevier academic press tags history pain palaeopathology comments 3 comments categories ann oakley bioarchaeology fibrous dysplasia fracture history joanna bourke mortuary archaeology palaeopathology personal personal reflection polyostotic fibrous dysplasia public health wellcome trust x ray older entries follow enter your email address to follow this blog and receive notifications of new posts by email email address follow join 987 other subscribers blog stats 2 365 751 hits blog archive blog archive select month august 2024 1 may 2021 2 may 2020 1 march 2020 1 october 2019 1 september 2019 1 april 2019 1 march 2019 2 february 2019 1 november 2018 1 october 2018 1 august 2018 1 july 2018 1 march 2018 1 february 2018 1 january 2018 1 december 2017 1 november 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