Critically applying the Index of Care to a context-limited cases: An example from medieval Sainte-Agnès (France)

OBJECTIVE: To assess fracture healing and residual malalignment in a femur using the Index of Care, and to develop a way to infer functional limitations, assistance needs, and potential support when limited individual and burial-context information. MATERIALS: An isolated adult right femur from a commingled funerary assemblage from the medieval castrum of Sainte-Agnès, in the former County of Ventimiglia, dated to 1034-1178 CE. METHODS: Macroscopic examination, computed tomography, and AMS radiocarbon dating were integrated within the four stages of the Index of Care. The degree of certainty associated with the different interpretations was assessed qualitatively. RESULTS: The analysis identifies a traumatic fracture of the proximal femoral shaft with complete bony union, persistent malunion, and no identifiable skeletal signs of chronic infection. These findings indicate prolonged survival and suggest reduced mobility and functional independence during healing, with potential assistance needs in daily activities. CONCLUSIONS: Careful diagnosis alongside the critical application of the Index of Care structures the interpretation of potential forms of support at Sainte-Agnès and can be adopted to assess other populations by making the degree of certainty explicit despite limited individual-level information. SIGNIFICANCE: In cases where the degree of certainty for the diagnosis is high but decreases as interpretation moves towards function can lead to hypotheses when care is taken to avoid conflating what is strongly supported with what is only plausible or indeterminable. LIMITATIONS: Evaluating the scope and potential care offered to this individual is limited by the single skeletal element available for analysis and the complex burial context.