Traumatic bowing deformities in tubular bones

Is bowing in long bones from an archaeological context representative of postmortem damage or genuine antemortem pathology? Bowing deformities (also known as traumatic bowing deformities, plastic bowing deformities, plastic bowing fractures and acute bowing fractures in the clinical literature) are true pathological entities that have only recently been recognized by clinicians. Bowing in long bones results from a force that exceeds the elastic properties of a given bone, producing a new plastic (bowing) response phase. These subtle deformities commonly affect the radii and ulnae in children and less frequently other tubular bones of the skeleton. Traumatic bowing should be considered as a possible diagnosis whenever abnormal curvature of a long bone is observed. This presentation illustrates two cases of traumatic bowing isolated from two ossuary populations from Ontario, Canada and addresses differential diagnostic concerns. © 1998 John Wiley & Sons, Ltd.     

Metastatic carcinoma in a leper skeleton from a Medieval cemetery in Chichester England

Both leprosy and metastatic cancer are well documented in the literature on human skeletal palaeopathology. The manifestation of both pathological conditions in a single archaeological skeleton has not been reported. A case from a Medieval site in Chichester, England exhibits bone lesions and patterns of skeletal involvement indicative of both these diseases. Evidence of leprosy is largely restricted to the lower tibiae, fibulae and the bones of the feet. Fine destructive foci and reactive fibre bone associated with metastatic cancer are distributed in many of the remaining areas of the skeleton. There is minimal overlap in the areas of the skeleton involved in the two pathological processes.     

Sclerosing Bone Dysplasia from 16th Century Sardinia (Italy): A Possible Case of Camurati–Engelmann Disease

The skeletal remains of a male aged 45–55 years displaying several bone anomalies were unearthed from the Alghero (Sardinia) plague cemetery ‘lo Quarter’, a burial site dating back to the 1582–1583 AD outbreak. The skeleton, whose stature is about 165 cm, presents a bilateral hyperostosis with increased diameter of the diaphyses of all the long bones of the upper and lower limbs; the metaphyses appear to be involved, while the epiphyses are spared. Marked thickening of the cranial vault is also evident. Radiological study showed irregular cortical thickening and massive endoperiosteal bone apposition; sclerotic changes are observed in the diaphysis of some metacarpals. Computed tomography (CT) cross sections of the long bones displayed a thickening of the cortical portion and endoperiosteal bone apposition. The individual was affected by a sclerosing bone dysplasia, a genetic disease characterized by increased bone density. In differential diagnosis, several sclerosing bone dysplasia, such as hyperostosis corticalis generalisata, craniodiaphyseal dysplasia, craniometadiaphyseal dysplasia, pachydermoperiostosis and Camurati–Engelmann disease, as well as other disorders characterized by sclerosing manifestations, such as Erdheim–Chester disease, mehloreostosis and skeletal fluorosis, need to be considered. The anomalies observed in skeleton 2179 fit with the features of Camurati–Engelmann disease, which is the most likely candidate for final diagnosis. It is highly challenging to evaluate how such a condition may have influenced the individual's lifestyle in terms of development, mobility and quality of life. This individual was probably symptomatic and must have experienced common clinical symptoms, such as pain in the limbs and fatigability. However, the strong development of the muscular insertions and the degenerative changes in the upper limbs suggest that the mobility problems should not have prevented him from reaching a mature age and from performing essential daily activities. The presented case is the unique paleopathological evidence of Camurati–Engelmann disease so far diagnosed. Copyright © 2015 John Wiley & Sons, Ltd.     

Skeletal remains of dogs unearthed from the Van‐Yoncatepe necropolises

A total of 15 dog skulls and a number of bones have been discovered in two burial chambers dating from 1,000 BC in the necropolises of the Van‐Yoncatepe Castle in eastern Turkey. The finds were a dog skeleton in burial chamber M5 and 14 dog skulls and plenty of bones in burial chamber M6. It was determined on examination that the skeleton found in burial chamber M5 was an 11–12‐year female dog, and that the skulls unearthed from burial chamber M6 belonged to dogs with an age range of seven to eight months to 12–13 years. In the latter chamber, however, except for one skull whose sex could not be determined, one was ascertained to belong to a female dog and the rest to males. Calculations of 20 different indices and ratios were made on the skulls. This showed that these skulls were of the dolichocephalic type. It was observed that there were signs of a widespread periodontal disease and alveolar recession. Enamel hypoplasia and abscess chambers detected on the teeth, and deformations observed in the hard palate were evidence enough to suggest that these were undernourished dogs. There were also some facial fractures, which were noticed to have occurred before death. On the other hand, examination carried out on the bones revealed that the dogs were of medium size, and that they were likely to have had a withers height of 50–55 cm. The data obtained from both the burial chambers brought to light the fact that these dogs were more of the hunting or working types. Copyright © 2002 John Wiley & Sons, Ltd.     

Differential diagnosis of cartilaginous dysplasia and probable Osgood–Schlatter's disease in a Mississippian individual from East Tennessee

This paper details the differential diagnosis of an adult female skeleton displaying features consistent with a cartilaginous dysplasia and Osgood–Schlatter's disease. This burial was excavated in 1940 from a Mississippian platform mound at the DeArmond site (40RE12) in Roane County, Tennessee as part of the Works Progress Administration (WPA) and Tennessee Valley Authority (TVA) archaeological investigations. The right humerus and left femur of this individual display traits consistent with achondroplasia, such as shortened length and normal width. However, the rest of the long bones display typical morphology. The affected humerus and femur are 82 mm and 58 mm shorter than their counterparts, respectively. This makes for obvious asymmetry. A review of the various cartilaginous dysplasias was undertaken to identify those conditions concordant with the differential manifestation of the long bone asymmetry. Morphological and radiographic analyses were used to rule out possible diagnoses. The most likely candidate is enchondromatosis out of the presented conditions, as it most commonly affects the long bones, does not affect every bone in the skeleton, and is asymmetrical in its manifestation. In addition to the cartilaginous dysplasia, both anterior proximal tibial metaphyses of this individual display defects that are roughly triangular with pitted, irregular floors. Osgood–Schlatter's disease is caused by repeated trauma to the tibial tuberosity during childhood. This individual would have walked with an obvious limp, and perhaps the added biomechanical stress on both quadriceps muscles as a result caused the injuries and resultant defects to its attachment points. Evidence of these conditions in an adult indicates that the Mississippian people in this community offered some sort of social support to differently‐abled individuals. Copyright © 2009 John Wiley & Sons, Ltd.     

“The Roman Giant”: Overgrowth Syndrome in Skeletal Remains from the Imperial Age

A very tall skeleton was found during archaeological excavations in the territory of Fidenae, an administrative centre of the Roman territorial organization, situated along the Via Salaria about 7 km north of Rome (Italy). The individual was a young male, dated back to the Imperial Age (3^rd century AD), presenting a very tall but normally proportioned stature, estimated around 202 cm. The long bones showed incomplete epiphyseal union; therefore, the stature would probably have been taller, if he had lived longer. In this work, the metric data are compared with those from the Roman Imperial Age population, and differential diagnosis is discussed. The skeletal evidence is characteristic of a form of gigantism, a rare growth disease that may be linked to different syndromes. The most common etiology is associated with a dysfunction of the pituitary gland, which causes overproduction of the growth hormone (hGH) during childhood. This endocrine disorder stimulates cartilaginous activity at the growth plate, delaying epiphyseal fusion and resulting in increased bone length. Copyright © 2013 John Wiley & Sons, Ltd.     

Periostitis and osteolysis in a medieval skeleton from South‐West Hungary: (Leprosy,treponematosis, tuberculosis or hypertrophic osteoarthropathy) A diagnostic challenge!

This paper uses macroscopic and radiological examinations to provide differential diagnoses of pathological lesions in the well‐preserved skeleton of a young male from the medieval site of Zalavár in South‐West Hungary. Macroscopic inspection of the skeleton revealed conspicuous thickening of the tibiae and fibulae with ‘tree bark’ appearance of the cortex. Periosteal proliferations are also found on the calcanea and on the posterior part of the femora. The metatarsals showed bony proliferation and bone dissolution. No alteration of the axial skeleton or the skull was noted. Radiographs showed thickening of the cortex of tubular bones due to a multilayered type of periosteal apposition. The likelihood of these symptoms being the result of melorheostosis, hypervitaminosis A, fluorosis, thyroid acropachy, endosteal hyperostosis, tuberculosis (TB), hypertrophic osteoarthropathy (HOA), treponematosis and leprosy is reviewed. None completely explains the entire spectrum of pathological lesions in the current individual, but the individual may have suffered from two co‐existent diseases. As a clinical entity, the changes in the metatarsals are compatible with leprosy, whereas the periosteal proliferations of the lower limbs point to a diagnosis of HOA as a secondary syndrome. Thus, a combination of leprosy and TB is suggested as a potential diagnosis. Although not definitive, our differential diagnosis was able to exclude a number of conditions producing periosteal apposition. Copyright © 2011 John Wiley & Sons, Ltd.     

Túnel: A Case Study of Avian Zooarchaeology and Taphonomy

Although not often considered, there are many osteological characters unique to the avian skeleton that influence the taphonomy of bird bones. These characters are reviewed and their archaeological significance discussed herein. The presence of marrow in many avian long bones is important to interpretation of avian remains from archaeological sites because the presence of marrow affects bone density and, in turn, preservation. Other structural properties that affect avian bone preservation include cortical wall thickness, length and pneumatic state. Based on an analysis of approximately 10,000 bird bones from the archaeological site of Túnel, Tierra del Fuego, Argentina, I found that specific breakage patterns resulted from natural taphonomic processes acting as a result of the unique avian bone characteristics. This information may allow researchers to distinguish breakage patterns in avian bones resulting from natural taphonomic processes from breakage patterns that are culturally induced.     

Oral implications of labret use: a case from pre‐Columbian Chile

This paper examines the osteological evidence for a case of long‐term labret use in pre‐Columbian north Chile and the pathological conditions associated with it. The burials from the site of Solcor 3 (AD 400–900) included a complete skeleton associated with two quartz labrets. Analysis of the skeleton of this adult male revealed wear and polish on the labial surface of both mandibular canines, indicating that the labrets were worn as a pair on either side of the midline of the lower lip. In addition to these abrasion facets, there were also areas of periosteal reaction in the alveolar bone of the canines. These patterns were analysed from the perspective of the clinical dentistry literature and compared to archaeological data. It is concluded that this individual's dental health was affected by wearing labrets, although not as seriously as might be expected based on contemporary medical reports. Copyright © 2003 John Wiley & Sons, Ltd.     

Damage to Bird Bones in Pellets of GyrfalconFalco rusticolus

Fragmentation and digestion of bird bones in pellets of the gyrfalconFalco rusticoluswere studied. Remains of the axial skeleton, including the head, were very scarce. Whole bones were rarely preserved. Tibiotarsi and most other long bones were the best elements for the calculation of the minimum number of individuals. All types of bones were heavily modified by digestion: with a few exceptions, traces of digestion were observed on more than 80% of articular ends, nearly 100% of broken surfaces, and on some shafts.     

Multiple bone tuberculosis in a child from predynastic Upper Egypt (3200 BC)

Tuberculosis, one of the most ancient human diseases, was present in ancient Egypt and has been observed since predynastic times. Excavations in the predynastic to early dynastic necropolis of Adaima, Upper Egypt (3500–2700 BC) led to the discovery of a number of remarkably well‐preserved skeletons of children. The skeletal remains of a 4.5–5‐year‐old child dated from Nagada III A2 (3200–3100 BC) displayed various lesions on the post‐cranial skeleton: spondylitis on the thoracic (T12) and lumbar (L1) vertebrae, partial lytic destruction of the right radio‐ulnar joint, lytic lesions on the scapula and a clavicle, dactylitis on the short bones of hands and feet, enlargement (spina ventosa) and periosteal new bone formation on the long bones. Radiographs show well‐defined radiolucent (cyst‐like) lesions in the metaphysis and the diaphysis of long tubular bones (ulna, radius, femur, tibia, fibula). The lesions recorded during macroscopic and radiological analysis strongly suggest a case of multiple bone tuberculosis. The occurrence of this case of tuberculosis in a child provides a picture of a period where tuberculosis must have been endemic throughout the population living during the origins of urban settlement in Upper Egypt during the predynastic period. Copyright © 2009 John Wiley & Sons, Ltd.     

A case study of possible differential diagnoses of a medieval skeleton from Denmark: leprosy,ergotism, treponematosis,sarcoidosis or smallpox?

This paper uses macroscopic and radiological examinations to provide differential diagnoses of pathological lesions in the skeleton of a young woman, 20–25 years of age, which triggered the Danish palaeopathologist Vilhelm Møller‐Christensen's interest in leprosy. The skeleton was incomplete, but the majority of bones of the upper body, as well as the skull, were present. The pathological changes consisted of medullary and cortical lytic foci, periosteal reaction and enhanced cortical density. The lesions were most extensive on the left side, especially around the elbow, wrist and scapula. Treponematosis, leprosy, smallpox, ergotism, rheumatoid arthritis, tuberculosis and sarcoidosis are all reviewed with regard to bone and joint pathology and their likelihood of being the correct diagnosis. We concluded that the most plausible diagnosis is treponematosis, but neither sarcoidosis nor smallpox can be completely excluded. Copyright © 2007 John Wiley & Sons, Ltd.     

A 6000 Year‐old Fossil Dugong from Botany Bay: Inferences about Changes in Sydney's Climate,Sea Levels and Waterways

The excavation in the 1890s of a skeleton of the warm‐water marine mammal Dugong dugon, associated with Aboriginal artefacts, from a Botany Bay salt marsh, marked the beginning of speculation about climate and sea level change in Australia over the period of human occupation. The dugong bones have recently been dated, giving a conventional ¹⁴C age of 5520±70 years BP, which is consistent with three older ¹⁴C dates for a layer of buried trees that underlies much of the north Botany sediments. The carefully drawn cross‐sections of depositional strata produced by the original discoverers allow further interpretation of the pattern of Holocene sea‐level fluctuations in the Sydney region. Layers of estuarine sediment, such as the one containing the dugong skeleton, are inter‐bedded with peat layers containing in situ roots and stumps, suggesting that the site alternated between sub‐aerial exposure and submergence throughout the Holocene. The presence of the dugong is suggestive of warmer conditions, and its inland location indicates a more extensive Botany Bay in the recent past. This is in agreement with other work from southern New South Wales describing both warm‐water marine species and higher sea levels several thousand years ago.

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Dry-bone manifestations of rickets in infancy and early childhood

Rickets and osteomalacia are the subadult and adult expressions of a disease in which the underlying problem is a failure to mineralize bone protein (osteoid). The most common cause of this disease is a physiological deficiency in vitamin D. The associated problems include deformed bones and this condition is well known in pre-modern medical texts and documents as a fairly common cause of morbidity. Given these facts, it is surprising that the literature on palaeopathology provides very little evidence of this disease in archaeological human skeletal samples. The medieval sample (N=687) of human remains from Wharram Percy, North Yorkshire, England contains a remarkable subsample of eight burials in which a spectrum of pathological features is expressed. The subsample includes infants ranging in age from 3 to 18 months at the time of death. Ten abnormal bone features were identified in the subsample, including: (i) cranial vault porosity; (ii) orbital roof porosity; (iii) deformation of the mandibular ramus; (iv) deformation of arm bones; (v) deformation of leg bones; (vi) flared costo-chondral ends of ribs; (vii) irregular and porous cortex of the costo-chondral ends of the ribs; (viii) abnormality of the growth plates of long bones; (ix) irregular and porous surfaces of the metaphyseal cortex; (x) thickening of the long bones, particularly in the metaphyseal areas. Not all of these features were found in all of the cases. Nevertheless, the overall pattern of skeletal abnormality fits well with the anatomical and radiological conditions associated with rickets. © 1998 John Wiley & Sons, Ltd.     

Use of Computed Tomography and Three‐Dimensional Virtual Reconstruction for the Examination of a 16th Century Mummified Dog from a North German Peat Bog

The corpse of a well‐preserved dog was recovered from a peat bog in the region of Burlage, Germany, in 1953. The dog, which dates to the 16th century, retained extensive soft tissue and fur on the postcranial body, although the head is skeletonised. Computed tomography was used to determine the extent of the preservation of the soft tissue, to determine sex and age and to attempt to identify trauma, pathology and potential cause of death. The analysis of the CT data indicated that the dog was an immature or adolescent male. Substantial soft tissue was preserved, including some internal organs. The entire skeleton was present, with the exception of the mandible and parts of the paws; all of the bones were flattened and some were distorted because of demineralisation in the peat. Partial disarticulation of the vertebral column was postmortem, although there was no further evidence of trauma or pathology on the skeleton or soft tissue. The cause of death could not be conclusively determined. To the knowledge of the authors, this dog represents the only known example of a complete historical nonhuman bog body with preserved soft tissue. Copyright © 2011 John Wiley & Sons, Ltd.     

The Protohistoric ‘Quicklime Burials’ from the Balearic Islands: Cremation or Inhumation

Traditionally, the Balearic so‐called ‘quicklime burials’ of the Iron Age have been considered to be inhumations in quicklime. The general appearance of the bones, however, resembles more closely that of cremated bones. Laboratory tests reveal that the observed features of the bones from these burials, including cracks, thumbnail fractures and warping, cannot be explained by an inhumation in quicklime. The δ ¹³C value, Fourier transform infrared spectra, SF values and the low carbon content of the apatite moreover indicate a thermal manipulation of the bones. The ¹⁴C content is depleted with regard to the accepted archaeological age of the sample, which can best be explained by carbon exchange between bio‐apatite and fossil CO₂ released during the heating of limestone. This implies that the Balearic ‘quicklime burials’ must be interpreted as an elaborate cremation practice in presence of limestone. Copyright © 2013 John Wiley & Sons, Ltd.     

Klippel‐Feil syndrome in an Early Hungarian Period juvenile skeleton from Austria

The excellently preserved skeleton of a juvenile from the Early Hungarian Period (10^th century AD), recently excavated in Gnadendorf (Lower Austria), displays typical symptoms of Type II congenital ‘Klippel‐Feil syndrome’ (KFS): fused cervical vertebrae 2 and 3, and fused thoracic vertebrae 2 and 3. Other features observed in this skeleton clinically reported for KFS include a basilar impression and a spina bifida occulta. The bilateral symmetrical hypoplasia of the basilar part of the occipital bone is probably also linked to this syndrome, as well as the constricted external acoustic meati, which almost certainly led to hearing impairment. A cranial lesion and its possible consequences are discussed in the context of the specific KFS alterations. Copyright © 2006 John Wiley & Sons, Ltd.     

Metastatic carcinoma in a 14th–19th century skeleton from Constância (Portugal)

During 2002, the extensive archaeological excavations of the ancient Constância necropolis (Centre of Portugal), dated from 14th–19th centuries, resulted in the exhumation of 151 individuals. Among the several paleopathological cases, a middle‐aged female skeleton with osteolytic lesions in her skull, axial skeleton, upper limbs and femurs was observed. These pathological findings are characterised by an asymmetric pattern with osteolytic focus of distinct size and irregular shape. Some skeletal elements display both osteolytic and osteoblastic lesions. The latter exhibit deposition of fine layers of woven bone. Lesions were observed macroscopically and radiology was used as a complementary method of scrutiny, especially in cases of unclear observation. The case was diagnosed as that of a probable metastatic carcinoma due to the multifocal distribution of the lesions in areas of intense haematopoietic activity, their morphology and some osteoblastic responses, as well as the presence of pathological fractures in the ribs. The skeleton's sex and age at death are in agreement with the proposed diagnostic, constituting the first case of malignant carcinoma detected in non‐identified Portuguese human skeletal remains. Copyright © 2009 John Wiley & Sons, Ltd.