REVIEWS   

Minerva Ortopedica e Traumatologica 2010 October;61(5):449-62

Copyright © 2010 EDIZIONI MINERVA MEDICA

language: English

Medieval and early modern approaches to fractures of the proximal humerus: an historical review

Brorson S.

Department of Orthopaedic Surgery, Herlev University Hospital, Herlev, Denmark

The diagnosis and management of complex fractures of the proximal humerus have challenged surgical practitioners and medical writers since the earliest recorded surgical texts. Current knowledge of fractures of the proximal humerus has been obtained through pathoanatomical and biomechanical studies within the last two centuries. However, the historical preconditions for this development have not been studied. This paper reviews written sources from the fall of the Roman Empire to the late eighteenth century. Medieval and early modern writers mainly rely on the Hippocratic writings De Fracturis and De Articulationes. The Hippocratic account of the normal anatomy of the shoulder reveals some biomechanical insights. However, knowledge of bone and joint anatomy of the shoulder useful for surgical purposes is not found in medieval sources. Even in fourteenth century illustrations based on human dissections ‘naturalistic’ observations are rarely found. In Renaissance sources, knowledge of the musculoskeletal system useful for the understanding of shoulder pathology appears. The anatomical drawings by Leonardo da Vinci (1452-1519) demonstrate knowledge of the biomechanical properties of the shoulder, and Vesalius (1514-1564) gives a systematic account for the osteology and myology of the shoulder. In early eighteenth century, the Hippocratic approach is challenged and more gentle modes of reduction and bandaging are proposed. Desault (1744-1795) gives an account of the muscle traction responsible for displacement in fractures of the proximal humerus. Reports on open surgery for fractures of the proximal humerus appear in the scientific literature.