Living with lower limb traumas and below-knee amputation in a Jordanian Late Ottoman nomadic community

Abstract

Objective: Paleopathological analysis is combined with ethnohistorical, ethnographic and ethnomedical reports to assess the sociocultural implications for a historical nomadic Bedouin female following her survival of a below-knee amputation and multiple injuries to the stump.

Materials: A middle-aged female recovered from a nomadic-style burial dated to the Late Ottoman Period (1789-1918) in Jordan's Wadi ath-Thamad region.

Methods: Macroscopic and radiographic assessment.

Results: A supracondylar femur (Hoffa) fracture, knee complex injury and lower leg amputation were observed on the right lower limb. Other pathological lesions that may have affected movement included bilateral os acromiale, intervertebral disc disease, osteoarthritis and right hook of hamate fracture.

Conclusions: The individual survived a below-knee amputation, two injuries to the stump, and likely experienced lower back pain. Mobility may have been painful, but she likely functioned within the community performing gender-specific daily tasks within the family tent and designated community female workspaces. Ethnohistoric and ethnographic reports suggest that marital demotion by other wives or a return to her father's tent may have occurred.

Significance: Healed multiple injuries and amputation affecting one limb are rare in paleopathological literature.

Limitations: It is uncertain whether the amputation or either of the stump injuries occurred during the same event. If they resulted from separate events, slight hip joint osteoarthritis suggests that the amputation preceded the other injuries.

Suggestions for further research: Full pathological assessment of individuals with amputations may provide additional insight into impairment resolution, health problems and injury arising from impairment following amputation.

Keywords: Bedouin; Gender; Impairment; Injury; Middle East; Mobility; Supracondylar fracture.