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The Ernest Witte site (41AU36) is a large prehistoric cemetery located in Austin County, Texas. Excavations in 1974-75 yielded four discrete burial groups which ranged in date from the Middle Archaic to the Late Prehistoric (4500-500 BP). While examining the Middle Archaic burials, we discovered an adult male with a partially healed odontoid type III fracture of the C2. The fact that fracture was in the process of healing suggests that he survived his injury for several weeks, perhaps months before his death. During the Middle Archaic period (4500-3000 B.P.) this must have been an extremely rare injury. Surviving it for any length of time would have been very difficult. Odontoid fractures result in either sudden hyperflexion or hyperextension of the neck. Hyperflexion leads to an anterior displacement of the dens fragment with the atlas. Hyperextension leads to a posterior displacement of the dens (Anderson & D'Alonzo, 1974). To explore how this traumatic injury might have occurred in an Archaic setting, we examined the medical literature to determine the possible means for how this fracture occurs in a modern setting. Health officials typically encounter this form of fracture as a result of 1) motor vehicle accidents, which accounts far the highest number of C2 fractures, 2) falls from great heights, and 3) severe blows to the back of the head which accounts for a very small percent of these injuries (Anderson & D'Alonzo, 1974). Traumatic events 1 & 2 usually occur with multiple injuries (i.e. additional broken bones). Only event 3, a blow to the back of the head, can occur with minimal body damage. Given the lack of additional broken bones for this burial, we suggest that a severe blow to the back of the head is the best explanation for this specific fracture. We also offer cultural implications of how this individual might have survived his injury.

Thirty-six women who had sustained soft-tissue injury after a simple fall were compared with agematched controls who had suffered a fracture in a similar fall. Subjects aged 45-70 years who had suffered a fracture had significantly lower bone density in the proximal femur and lower grip strength than their controls. No differences in femoral bone density or grip strength were found between the two groups at ages over 70, but the women with fractures were on average of greater body weight than th no-fracture group. Bone mineral density declined more rapidly with age and was less closely correlated with body weight and time since menopause in the no-fracture group than among the women with a fracture. We conclude that the determinants of fracture vary with age; low bone density and low muscle strength are associated with fracture below the age of 70 but not at higher ages.

A 41-year-old man presented to the emergency department with acute-onset low back pain that began after his vehicle hit a large hole in the road the previous night. The pain [...]

Author Affiliation: (1) ARC Epidemiology Unit, Manchester University Medical School, Manchester, M13 9PT, UK Article History: Registration Date: 01/06/2004 Online Date: 11/08/2004 Article note: The online version of the original article can be found at http://dx.doi.org/10.1007/s00198-002-1364-1 European Prospective Osteoporosis Study Group. *Project leaders: J. Reeve, A.J. Silman. Data Management: T.W. O'Neill, J.D. Finn, S.R. Pye, W.C. Cockerill, A.A. Ismail, D.K. Roy. Participants: D. Banzer, Berlin, Germany L.I. Benevolenskaya, Moscow, Russia A. Bhalla, Bath, U.K. J. Bruges Armas, Azores, Portugal J.B. Cannata, Oviedo, Spain P. Delmas, Lyon, France G. Dilsen, Istanbul, Turkey J. Dequeker, Leuven, Belgium J. Falch, Oslo, Norway B. Felsch, Jena, Germany D. Felsenberg, Berlin, Germany C. Gennari, Siena, Italy K. Hoszowski, Warsaw, Poland I. Jajic, Zagreb, Croatia J. Janot, Bochum, Germany O. Johnell, Malmo, Sweden G. Kragl, Erfurt, Germany A. Lopez Vaz, Oporto, Portugal R. Lorenc, Warsaw, Poland G. Lyritis, Athens, Greece F. Marchand, Lyon, France P. Masaryk, Piestany, Slovakia C. Matthis, Lubeck, Germany T. Miazgowski, Szczecin, Poland M. Navez Diaz, Oviedo, Spain H.A.P. Pols, Rotterdam, Netherlands G. Poor, Budapest, Hungary A. Rapado, Madrid, Spain H.H. Raspe, Lubeck, Germany D.M. Reid, Aberdeen, U.K. J. Reeve, Harrow, U.K. W. Reisinger, Berlin, Germany C. Scheidt-Nave, Heidelberg, Germany J. Stepan, Prague, Czech Republic C. Todd, Cambridge, U.K. K. Weber, Graz, Austria A.D. Woolf, Truro, U.K. This report was prepared on behalf of the group by: S.R. Pye, T.W. O'Neill, M. Lunt, J.A. Kanis, C. Cooper, O. Johnell, J. Reeve, and A.J. Silman.

The causes of bone fractures, descriptions of bone fractures, treating bone fractures, and there types of treatment is discussed.

Byline: J. G. Heckmann (1), R. Stangl (2), F. Erbguth (1), H. Rutherford (3), B. Neundorfer (1) Author Affiliation: (1) Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91 054 Erlangen, Germany Tel. + 49(9131)8 53 44 57 Fax + 49(91 31)8 53 44 36, DE (2) Department of Orthopedic Surgery, University of Erlangen-Nuremberg, Erlangen, Germany, DE (3) Department of Anesthesiology, University of Erlangen-Nuremberg, Erlangen, Germany, DE Article note: Received: 3 December 1998 Accepted: 25 February 1999