Traumatic cubitus valgus consequent of distal humeral fracture: Two case studies from the Holocene Later Stone Age in southern Africa

Objectives

Distal fractures of the humerus and their complications have rarely been described or analysed in the palaeopathological literature. The objective of this study was to evaluate two cases of distal humeral fracture with associated cubitus valgus observed in two individuals from the context of the Later Stone Age (LSA) in southern Africa.

Materials

Skeletal remains of two individuals. A middle-aged female radiocarbon dated to c.160 BP and a middle-aged male radiocarbon dated to c.2 300 BP.

Methods

Remains were macroscopically and radiographically assessed for injury.

Results

Both cases presented with healed antemortem injury to the right elbow attributed to possible falls. Distal humeral fracture resulted in non-union of the lateral epicondyle with extensive morphological changes to the elbow joint including an increased carrying angle. Morphological and osteoarthritic changes suggest a survival period of several years post-injury.

Significance

Cubitus valgus following traumatic injury has rarely been reported amongst historic or prehistoric populations. The described injuries would have had physical and functional consequences, raising questions relating to probable care received during the healing process. The elbow injuries would have resulted in restricted motion and instability of the elbow joint, with a high likelihood of ulnar neuropathy.

Limitations

The contextual information for these individuals is limited and do not permit broader population level study.

Suggestions for further research

Formal biomechanical analysis including cross-sectional geometry analysis will provide further information regarding complications and strengthen the diagnosis of ulnar neuropathy. Further research is necessary on the prevalence and complications of humeral fracture.