Evidence of Stress Fracture in a Homo antecessor Metatarsal from Gran Dolina Site (Atapuerca,Spain)

We present the palaeopathological analysis of a right fourth metatarsal (ATD6‐124) recovered from the Atapuerca–Gran Dolina site (Spain). This fossil, ca. 1 Ma, belongs to Homo antecessor, the earliest known European hominin species. The metatarsal exhibits a proliferative lesion on its medial periosteal surface. Periosteal reaction can be the bone response to a wide number of injurious processes. We describe a lesion on the basis of macroscopic and microscopic analyses, including microtomography and scanning electron microscopy. Externally, the osteoblastic lesion presents a highly porotic and disorganised morphology. Internally, we observe a series of micro‐fractures on the compact bone that do not affect the medullary canal. We provide a differential diagnosis and suggest that the ATD6‐124 lesion could correspond to a pedal stress fracture, also known as fatigue or march fracture. Stress fractures have been related to a load increase and muscular fatigue. This type of fracture has been widely reported in the foot of soldiers and athletes, which are usually engaged in strenuous, excessive or prolonged locomotive activities. Despite its high frequency in these groups, stress fractures have not been reported as such in fossil collections, with the exception of a metatarsal belonging to the Sima de los Huesos site (Atapuerca). Copyright © 2013 John Wiley & Sons, Ltd.     

A nineteenth-century case of carcinoma of the prostate,with a note on the early history of the disease

A case of prostatic carcinoma is described in the skeleton of a named individual who died in 1834. The tumour was recognized from widespread periosteal new bone throughout the skeleton and by the presence of sclerosing metastases in many bones, including the pelvis and all the vertebrae. A number of features of the disease present here are said to be uncommon in modern patients, including spiculated periosteal new bone and some degree of spinal stenosis. In two previous cases of prostatic carcinoma described in the literature, periosteal new bone was a prominent feature and was probably responsible for the disease being recognized. It is likely that if skeletons from mature males were routinely X-rayed, considerably more cases would be noted and a more accurate estimate of the prevalence of this disease in the past would thus be ascertained. © 1997 John Wiley & Sons, Ltd.     

Septic bone changes in leprosy: A clinical,radiological and palaeopathological review

Infective lesions of bone in leprosy are of two types. In the rhinomaxillary syndrome, superficial infective changes in the bones of the maxilla are due to the presence of Mycobacterium leprae. Lytic foci in the medulla or the outer cortical surface may be due to Mycobacterium leprae at the site as granulomatous lesions. The most frequent infective bone changes in leprosy are, however, sequelae of regional anaesthesia and soft tissue ulceration. The bone lesions are due to pyogenic bacteria and the nature of these infective lesions is similar to that in non-leprous conditions. The pyogenic lesions in leprosy are restricted to the bones of the hands, feet and lower legs.     

Skeletal Manifestations of Skin Ulcer in the Lower Leg

Skin ulcers of the lower leg are known to cause both destructive and, more commonly, bone‐forming lesions. Typically, bone‐forming lesions in this disorder have clearly defined margins although there may be extensive reactive bone formation involving much or all of the adjacent diaphysis. These lesions are best described in patients from tropical areas, and in these environmental contexts, these are known as tropical ulcers, but leg ulcers can be caused by a variety of diseases and conditions, of which vascular insufficiency plays an important role among the elderly. The lesions are important clinically because of the disability associated with the ulcer and because of complications that can develop including osteomyelitis and cancer. In most cases, the bone lesions caused by ulcer are easily diagnosed in archaeological human skeletal remains and provide some insight into the prevalence of this disorder in antiquity. In this paper, we review the gross and radiological manifestations of bone lesions resulting from overlying skin ulcer in tibiae of 13 cases including archaeological and modern medically documented skeletons. In two of the cases, there is medical documentation regarding the presence of a chronic ulcer on the lower leg. The objectives of this paper were to explore the diversity of bone lesions associated with ulcers of the tibia and to provide an improved basis for the diagnosis of this disorder in human skeletal remains. Copyright © 2011 John Wiley & Sons, Ltd.     

Child Health in Five Early Medieval Irish Sites: A Multidisciplinary Approach

With the aim to reconstruct child health in five early medieval (5th–12th c. CE) Irish sites, an osteoarchaeological study of three biological stress indicators – cribra orbitalia, linear enamel hypoplasia (LEH) and periostitis – has been conducted on 229 skeletons. In addition, Irish early medieval written sources testifying on child health during this period were consulted. These data were furthermore combined with the results of stable isotope analyses (nitrogen and carbon) conducted on subadult bone specimens. Cribra orbitalia was found in 27.5% of the studied individuals (48.6% of subadults were affected), with only two cases active at the time of death. The prevalence of LEH per individual is 63.5% (78.9% in subadults and 59.7% in adults). The age ranges of LEH formation vary between 1.9 and 4.8 years for the maxillary teeth and between 1.8 and 6.2 years for the mandibular teeth. Periosteal inflammations were recorded in over one third of the studied subadults (36.2%) with six cases active at the time of death. The stable isotope results suggest a diet based on terrestrial food sources, with little or no marine input. The presented data strongly suggest that most of the individuals were exposed to a high level of physiological stress during their childhood, and as such does not support the so called ‘osteological paradox’ hypothesis. The observed disturbances were probably caused by a synergistic effect of various biological and socio‐cultural factors. Although the historical records indicate certain differences in diet and lifestyle between social classes and the sexes, this study showed that the children of all ages had poor health in all social classes across a wide geographical location for the full time period of the early medieval. Copyright © 2016 John Wiley & Sons, Ltd.     

Bridging the gap between forensic anthropology and osteoarchaeology—a case of vascular pathology

We report on two cases of similar bony lesions and emphasize the importance of cooperative work between forensic anthropology and forensic pathology. A fairly well preserved cadaver of an old woman was autopsied by a forensic team at the National Institute of Forensic Medicine in Portugal. Although age at death and sex were easily determined, there was insufficient other evidence for personal identification. However, the female revealed severe and extensive lesions in both lower legs and these were useful for determining personal identity. Here we describe the pathological findings, consistent with venous chronic insufficiency. The woman's family subsequently confirmed she suffered from this condition. Furthermore, they informed us of varicose ulcers, which also were suspected by the ties found, in both her legs, during autopsy. A long history of venous chronic insufficiency was subsequently found in her medical records. We compare these forensic findings to the bony pathologies of a male skeleton from the Coimbra Identified Skeletal Collection not previously diagnosed. We argue that these two cases represent the same pathological condition. Without the medical forensic work, the skeletal remains of the second case might not have been positively identified. The benefits of cooperative work between medical and anthropological forensic specialists are reinforced leading to resolution of otherwise unidentified skeletal pathological conditions. Copyright © 2004 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.     

Pre-Columbian treponematosis in medieval Britain

There has been much debate regarding the origins of treponemal disease and, in particular, acquired syphilis. Greater numbers of skeletons with apparently diagnostic bone lesions in the New World than in the Old have given rise to the postulate, particularly advanced by American workers, that the disease originated there prior to AD 1492 and was carried back to the Old World by Columbus's sailors. This paper presents evidence for the presence of treponemal disease in medieval Norwich prior to AD 1492, however. The dating of the site is good and the skeleton concerned comes from a well-sealed context. Others in the group have similar lesions and there are four individuals with evidence of leprosy. All were buried in a communal cemetery. The individual has widespread, bilateral, florid periostitis, especially of the tibiae and fibulae, and the radiographic changes support the diagnosis of treponemal disease. Differential diagnosis and geographical situation suggest that this skeleton displays evidence of syphillis.     

An analysis of chronic osteomyelitis of the tibia in a pre-columbian human population using radiographic–pathological correlation

Radiologic-pathologic correlation is employed in pre-Columbian tibia specimens as a means of understanding the characteristic alterations induced by untreated chronic osteomyelitis.