The papyrus is incomplete and fractures of the humerus are the only limb fractures dealt with. The papyrus contains 48 cases of wounds and fractures topographically ordered from the skull to the chest and upper arm. (Courtesy of The New York Academy of Medicine Library, New York, NY.) Illustrations of reduction procedures and bandaging from surgical texts from the sixteenth and seventeenth centuries are included and possible complications are discussed.Ĭolumns XII and XIII of The Edwin Smith Papyrus are shown. In this study, I review the most important written contributions from Ancient Egypt, Greece, and Rome. Moreover, the available anatomic knowledge may have posed some limitations for providing multifaceted treatments and precise pathoanatomic analyses of fractures, dislocations, fracture-dislocations, and soft tissue injuries of the shoulder and upper arm. Tools and weapons, for example, maces and battle-axes in stone and copper, may have caused a different clinical picture at the time of The Edwin Smith Papyrus. The expected length of life among ancient Egyptians in the Dynastic Period was approximately 36 years and the onset of menopause and pattern of bone loss were likely different. However, historical sources based on ancient populations should be interpreted cautiously. Ancient authors often included a discussion of compound fractures of the humerus, suggesting these injuries were a major concern.
Most procedures recommended by ancient authors would be termed nonsurgical or conservative today. The recommended techniques for reduction followed by bandaging and splinting remained remarkably unchanged until the late nineteenth century when the introduction of anesthesia and radiology enabled surgeons to plan and perform surgery in a modern sense. Management of fractures of the humerus has been discussed in surgical texts for more than three millennia. 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. Illustrations from sixteenth and seventeenth century surgical texts are included to show the ancient methods of reduction and bandaging. In Late Antiquity, complications from powerful traction or tight bandaging were described by Paul of Aegina (circa AD 625–690). He described different fracture patterns, including transverse, oblique, and multifragmented fractures. Celsus (25 BC–AD 50) distinguished shaft fractures from proximal and distal humeral fractures. 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. 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. Reduction by traction followed by bandaging with linen was recommended.
In the earliest known surgical text, The Edwin Smith Papyrus (copied circa 1600 BC), three cases of humeral fractures were described. Fractures of the humerus have challenged medical practitioners since the beginning of recorded medical history.
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