Echoes of Unwoven Breaks: A Paleopathological Literature Review of Nonunion Fractures

Abstract

This study presents a wide literature review of nonunion fractures in paleopathological contexts, including the description of a new case from Idanha-a-Velha (Castelo Branco, Portugal). Nonunion factures, characterized by the failure of broken bone fragments to reunite properly, are rare in the paleopathological record. This review aims to gather and analyze existing cases of this condition, using academic databases and specific research terms related to this type of fracture. This survey included a total of 75 publications describing 155 nonunion fractures in 137 adult individuals: 44 males, 28 females, and 65 of unknown sex. The publication record includes more Prehistoric and Modern cases than those dated from Medieval or Ancient periods. The ulna exhibited the highest overall frequency of nonunion fractures, with 53/155 (34.2%) distributed across six different anatomical regions, primarily at the distal end (Parry fracture). However, when assessing the frequency of nonunions by specific anatomic region, the femoral neck shows a higher rate (23/30; 76.7%) compared to the ulnar distal end (6/53; 11.32%). Male individuals display a higher prevalence of nonunion fractures throughout the skeleton, except for the clavicle, metatarsals, os coxae, and ulna, which affected more often females. Moreover, femoral neck nonunion fractures are more frequent in mid-20th century male paleopathological cases, while ulnar fractures are more common in prehistoric females. The comparison between these patterns and clinical data highlights that past and current populations have different patterns of nonunion fractures. In the modern clinical literature, a greater prevalence of tibial, fibular, femoral, and humeral nonunions is recorded due to traffic accidents; while in past populations, ulnar nonunion fractures are substantially more frequent. Further studies comparing fracture patterns across different time periods may allow to clarify whether these trends reflect changes in medical treatment, lifestyle, or bone health over time.