Management of Fractures of the Humerus in Ancient Egypt, Greece, and Rome: An Historical Review

Abstract

Fractures of the humerus have challenged medical practitioners since the beginning of recorded medical history. In the earliest known surgical text, The Edwin Smith Papyrus (copied circa 1600 BC), three cases of humeral fractures were described. Reduction by traction followed by bandaging with linen was recommended. In Corpus Hippocraticum (circa 440-340 BC), the maneuver of reduction was fully described: bandages of linen soaked in cerate and oil were applied followed by splinting after a week. In The Alexandrian School of Medicine (third century BC), shoulder dislocations complicated with fractures of the humerus were mentioned and the author discussed whether the dislocation should be reduced before or after the fracture. Celsus (25 BC-AD 50) distinguished shaft fractures from proximal and distal humeral fractures. He described different fracture patterns, including transverse, oblique, and multifragmented fractures. In Late Antiquity, complications from powerful traction or tight bandaging were described by Paul of Aegina (circa AD 625-690). Illustrations from sixteenth and seventeenth century surgical texts are included to show the ancient methods of reduction and bandaging. The richness of written sources points toward a multifaceted approach to the diagnosis, reduction, and bandaging of humeral fracture in Ancient Egypt, Greece, and Rome.

Gendered Differences in Accidental Trauma to Upper and Lower Limb Bones at Aquincum, Roman Hungary

“…Classical authors knew the importance of rapid and effective fracture reduction, and also recognized complications associated with certain difficult to manage fracture types and locations (Brorson 2009). Roman physicians were trained by practical experience and apprenticeship, rather than in medical schools, and remedies from medicine makers and magicians may have been considered as alternatives to a doctor's care (Cilliers and Retief 2006;Redfern 2010;Scarborough 1970).…”

Aeginalı Paul: Bizans döneminde ünlü bir cerrah ve tıp doktoru

“…Epitomun 6. kitabında travmatik kı-rıkları; transvers, longitüdinal ve birleşik kırıklar olarak ve bir bölgedeki kırıkları düz ya da yarımay şeklinde sınıflan-dırmıştır (35,36) Humerusun proksimal kırıklarında altı bandaj uygulamasını önermiştir. Bandajlar balmumlu merhem sürülmüş keten kumaştan yapılmaktaydı.…”

Management of Proximal Humeral Fractures in the Nineteenth Century: An Historical Review of Preradiographic Sources

“…The clinical diagnosis of shoulder injuries was based on assessment of the surface characteristics, crepitus, ROM, and pain localization. The difficulties of distinguishing displaced or impacted fractures of the proximal humerus from glenohumeral dislocations and fracture-dislocations have been discussed in the surgical literature since the third century BC [5].…”

“…The management of fractures of the proximal humerus has challenged medical practitioners since the earliest recorded medical texts [5]. The recommendations established by the ancient Greek and Roman medical authorities remained remarkably unchanged throughout medieval and early modern medicine [6].…”