Perimortem fracture manifestations and mortality after hip fracture in a documented skeletal series

Objective: Unhealed hip fractures are underrepresented in the archaeological record, suggesting that better identification criteria are required. This paper evaluates whether a sample of documented perimortem hip fractures displayed classic perimortem features and which features may facilitate better identification of such fractures in the archaeological record. Materials: Ten individuals from the Robert J. Terry Anatomical Skeletal Collection with documented hip fractures and intervals of survival. Methods: We observed the skeletal remains macroscopically and with a Keyence VHX-2000 digital microscope at a range of 5x to 100x magnification. Results: 90% of the individuals and 64% of the fragments had identifiable perimortem features; hinging was the most consistent feature. Eburnation was found in two individuals who died 13 days after sustaining a hip fracture. Conclusions: This study underscores the importance of examining fracture margins for evidence of hinging. Eburnation may be added to the list of potential perimortem fracture identification criteria. Significance: Identifying perimortem trauma unequivocally remains challenging. Using collections with documented perimortem fractures aids in determining which criteria are most likely to appear in archaeological human bone. Limitations: The fracture location patterning (70% intertrochanteric) may be the result of sample selection. Suggestions for future research: Further intensive comparative investigation with the Hamann-Todd Collection would elucidate patterns further.