Segmental Femoral Fracture Malunion: Evidence and Prognostic Analysis of Medical Intervention in the 3rd Century BC

Abstract We examined the remains of an individual who was unearthed from the Tuchengzi site and was believed to be from the Warring States period in China. The remains exhibited segmental femoral fracture. We aimed to deduce the cause of fracture, medical interventions, healing process, and motion behavior after fracture healing using several techniques, including macroscopic observation, computed tomography, and finite element analysis. The findings suggested that the segmental nature of the fracture was likely caused by the same occupational activity. The morphology of the healed fracture indicated that the individual underwent medical intervention. The fracture healing process signified that the lower extremity underwent adequate fixation, while bone callus remodeling suggested the recovery of lower-extremity load-bearing capacity. The finite element analysis demonstrated that the fracture healed to such a degree that it could withstand the load of standing, but not the load of normal walking. We suggest that medical practitioners in the Warring States period possessed a good knowledge of thigh anatomy, enabling them to guide fracture reduction and fixation. Reasonable medical intervention facilitated fracture healing and load recovery. Although the individual was able to stand, walking necessitated compensatory movement or instrumental assistance due to femur deformity resulting from fracture healing.