In 1985, archaeologists discovered a medieval necropolis in northern Italy, which, over the years, yielded the remains of 222 individuals. Amid these remains, the skeleton of one adult male stood out because his hand appeared to have been amputated at the mid forearm—a type of traumatic injury that is rarely observed in the archaeological record.

But the story gets even stranger. As George Dvorsky reports for Gizmodo, archaeologists recently re-examined the skeleton and uncovered evidence to suggest that the medieval man relied on an unusual prosthesis in the wake of the amputation: an iron knife.

The necropolis where the man’s remains were found appears to have been built by Longobards, a Germanic people that ruled over Italy in the High Middle Ages. The skeleton with the amputated hand, known as T US 380, has been dated to between the 6th and 8th centuries. T US 380 was between 40 and 50 years old when he died.

In a paper published in the Journal of Anthropological Science, researchers write that the man’s limb appears to have been removed by blunt force trauma, but they aren’t sure exactly how or why. He may have undergone some sort of surgical procedure or, given the “warrior-specific culture of the Longobard people,” lost his hand in a fight. It is also possible that his limb was cut off as a form of punishment.

What is more clear, the researchers say, is that the man’s remains show signs of having been shaped by a prosthetic limb. T US 380 lived for years after his amputation, and while his injuries healed up nicely, the study authors observed that his tissue had formed callus, a thick layer of skin that develops when an area is subjected to friction. This, the researchers say, suggests there may have been a “biomechanical force” applied to the stump—a prosthesis, in other words.

The man’s teeth, which showed signs of “extreme” wear, also produced some clues to support this theory. On the right side of his mouth, his teeth were so worn down that the pulp cavity opened, causing a bacterial infection, according to Michelle Starr of Science Alert. The study authors think that the man was using his teeth to tighten the straps on his prosthesis. His shoulders also suggest that this was the case. The man’s upper arm bone had shifted slightly, and his shoulder had developed a C-shaped ridge, possibly because he was frequently holding his arm in an unnatural position so he could grip the straps with his mouth.

For more details on what the prosthesis may have looked like, researchers turned to objects discovered near the man's remains. While other male skeletons in the Longobard necropolis were found with their arms by their sides, T US 380 had his right arm laid across his torso. Next to the arm was an iron knife, with the handle aligned with the amputated hand. Archaeologists also discovered a bronze D-shaped buckle, and remnants of an organic material, which they believe was leather.

“[W]e suggest that a prosthesis might have taken the form of a cap with a modified bladed weapon attached to it,” the study authors write. The knife, they theorize, was attached to the cap, which was placed over the man’s stump and fastened with leather straps and the buckle.

Relying on a pointy weapon as a prosthesis may not seem like the most practical choice, and researchers can’t be sure how the man used his makeshift limb. It may have helped him perform daily tasks, like eating, or may have been used for self-defense.

But the man certainly wouldn’t have been able to survive without people around to help him. The fact that he was able to live through a forelimb amputation in an era before antibiotics is, the researchers write, “remarkable.” People in his community would must have helped keep him in a clean environment and taken measures to staunch his blood loss—possibly through herbal balms.

“The survival of this Longobard male,” the study authors write, “testifies to community care, family compassion and a high value given to human life.”