A Type III Odontoid Fracture of the Axis (C2) from the Middle Archaic of the Texas Gulf Coastal Plains

Article excerpt

The Ernest Witte site (41AU36) is a large prehistoric cemetery located in southeast Texas. Four discrete burial groups were excavated from 1974-1975, the oldest dating to the Middle Archaic (3000 1500 B.C.). While examining the burials from this group, a 35-50 year old adult male was found with a partially healed Type III fracture of the odontoid process of the axis (C2). A review of the clinical literature was undertaken to help determine how this injury could have been sustained and survived in an Archaic setting. The most frequent modern causes for this injury include 1) motor vehicle accidents, 2) falls from heights, and 3) severe blows to the back of the head. Given the etiology of odontoid fractures, it is not possible to determine if the break was caused by intentional or accidental violence. Type III fractures are frequently associated with severe neurological complications, including death. While this individual survived long enough for the break to partially heal, the injury probably caused his demise.

Keywords: trauma, odontoid fracture, dens, Texas

The Ernest Witte site (41AU36) is a multicomponent prehistoric cemetery located in Austin County, Texas (Figure 1). The site was excavated from 1974-1975 by Hall (1981:1) under the aegis of the Texas Archeological Survey. A total of four discrete burial groups were recovered, which ranged from the Middle Archaic to the Historic (c. 3000 B.C.-A.D. 1700) time periods (Hall 1995).

Group 1 was dated via radiocarbon assays to the Middle Archaic period (3000-1500 B.C.). It contained 45 burials (Hall 1981:49) representing 67 individuals (Taylor 2001:61). Recovered cultural artifacts suggest that the location was a habitation site as well as a cemetery (Hall 1981:30). The people of the Middle Archaic time period on the Texas Gulf Coastal Plain are thought to have been hunter-gatherers that exploited seasonally abundant, but spatially fixed, resources. During the Middle Archaic, a rising regional population led bands to utilize defined territories and make use of cemeteries to "lay claim" to resource patches (Hall 1995, 1998; Story 1985).

The human skeletal remains from the Middle Archaic portion of the site were recently examined in order to perform a biocultural, populationbased assessment of the group's health and adaptation. During the course of the assessment, a middle adult male (35-50 years of age) was found to have a partially healed fracture of the odontoid process of the second cervical vertebrae (C2 or axis).

BACKGROUND TO ODONTOID FRACTURES

Injuries to the cervical spine, especially the odontoid, are rare in the archaeological record. A review of the English language literature produced only one possible example of an odontoid fracture. Anderson ( 1987) reported a hypoplastic dens, possibly resulting from trauma, in a male from a medieval Norwegian cemetery. While uncommon archaeologically, injuries to the cervical spine are not without precedence on the Texas Gulf Coastal Plain. An individual who had sustained and survived a break of the Cl (atlas) and C2 (axis) was found in the Late Prehistoric skeletal sample from the Mitchell Ridge site (41GV66), located on Galveston Island (Powell 1994).

Fractures of the odontoid process have been classified into three types (Figure 2) by Andersen and D'Alonzo (1974). A Type I break is an avulsion fracture through the top of the odontoid at the alar ligament attachment. Type II fractures occur at or near the junction of the odontoid process and the vertebral body. Type III fractures include the vertebral body within the break. Revisions to this classification have been suggested by subsequent researchers. Burke and Harris (1989) argue that the Type I fracture is not a true dens fracture, while Hadley and coworkers (1988) have added a Type Ha subtype. For this report, the classification by Anderson and D'Alonzo will be used, since it is the most widely applied method of assessing odontoid fractures. …