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.

Fig. 1

Columns XII and XIII of The Edwin Smith Papyrus are shown. (Courtesy of The New York Academy of Medicine Library, New York, NY.)

Fig. 2A–C

(A) A proximal fracture of the left humerus (posterior view) is shown, which healed with considerable displacement. The humerus is from a young woman found in Egyptian Nubia in the first or middle part of New Kingdom (circa 1539–1075 BC). (Courtesy of Laboratory of Biological Anthropology, University of Copenhagen. Photograph by K. Stub. Reprinted with permission.) (B) A proximal fracture of the right humerus (lateral view) is shown, which healed with angular and rotational displacement. The humerus, from a young woman, is shortened approximately 2 cm and was found in Egyptian Nubia during the first or middle part of New Kingdom (circa 1539–1075 BC). (Courtesy of Laboratory of Biological Anthropology, University of Copenhagen. Photograph by K. Stub. Reprinted with permission.) (C) Anteroposterior and lateral radiographs of a right humerus with healed fractures of the shaft and proximal part of the humerus found in Qau (circa 1400 BC) are shown. (Reprinted from Bourke JB. Trauma and degenerative diseases in ancient Egypt and Nubia. J Hum Evol. 1972;1:225–232 [3], with permission from Elsevier.)

Fig. 3A–B

Interpretations of the Hippocratic mode of reduction for fractures of the humerus (De Fracturis, VIII) [10] are shown. (Reprinted from (A) Primatice (1504–1570) [23], with permission from Bibliothèque national de France, Paris, France), and (B) Joannis Scultetus (1595–1645) [24]. (With permission from the John Martin Rare Book Room, University of Iowa, Iowa City, IA.)

Fig. 4

An illustration of Oribasius’ mode of reduction for humeral fractures and glenohumeral dislocation using the Hippocratic bench, scamnum, is shown. (Reprinted from Vidius [29] and Brockbank W. The man who was Vidius. Ann R Coll Surg Engl. 1956;19:269–295, with permission from the Royal College of Surgeons of England, London, UK.)

Fig. 5A–B

(A) The spica simplex is recommended by Galen in De Fasciis (Opera Omnia, XVIII A, 768–827) [10] after reduction of proximal humeral fractures, shoulder dislocations, and fractures of the clavicle. (Reprinted from Galen [10], with permission from Bibliothèque national de France, Paris, France.) (B) By application of an additional bandage around the breast after placing compresses under the elbow, a valgus pressure can be obtained. (Reprinted from Primatice [23], with permission from Bibliothèque national de France, Paris, France.)