Evidence of possible lower limb amputation in a tomb in an Ancient Egyptian necropolis: the report of an on-site radiographic analysis

Despite the existing literature, the use of surgery to treat medical diseases in Ancient Egypt remains controversial. Regarding amputations, such procedures were performed in Egypt for therapeutic reasons, although they were never described in medical papyri. Here we present the radiographic study of a possible lower limb amputation found in a recently discovered tomb in Aswan, Egypt. Case presentation: The necropolis is located on the west bank of the Nile, around the Mausoleum of the Aga Khan III. Around 45 mummies were found in the tomb, along with more than 400 mixed bones of adults and subadults. Radiographic analyses were carried out directly on-site in the proximity of the tomb using a digital portable device. Among the mixed bones, we found a mature right femur with evidence of mid-diaphyseal bone interruption and exuberant reparative callus at the broken stump with woven periosteal new bone, indicating a recent and active healing process at the time of death. The X-ray study confirmed the presence of a mid-diaphyseal transverse fracture, highlighting the relatively sharp margins which were suggestive of a transverse cut at this point. A slightly radiopaque bone callus was visible as osseous spurs with circumferential and proximal directions; the exuberant bone callus revealed an ante-mortem trauma, suggesting the hypothesis of certain types of amputation. The x-ray showed no clear signs of other bone diseases or advanced taphonomic processes. Among the commingled remains, we also found the mature distal epiphysis of a right femur with radiographic evidence of extensive bone remodeling at the proximal broken stump. However, we cannot ascertain that these two femoral pieces corresponded to the same individual. Conclusions: Further studies will better clarify the causes of the bony lesion, which may be related to possible amputation of fracture from high-force blunt trauma. At present, the most likely cause relies on interpersonal violence, accidental occupation trauma and/or therapeutic treatment. Our report highlights how conventional radiology can still provide important results in the field of paleopathology, thanks to the possibility of using portable radiological devices directly on archaeological sites, thus overcoming technical difficulties in transporting bone mummified remains.