Asymmetric midshaft femur remodeling in an adult male with left sided hip joint ankylosis, Metal Period Nagsabaran, Philippines.

OBJECTIVE: This study investigated microstructural changes of the right and left midshaft femur in an archaeological individual afflicted with left-sided hip joint ankylosis to assess whether increased cortical porosity was present as a result of leg disuse. MATERIALS: The individual is a middle-aged adult male excavated from the Metal Period (∼2000 BP) Nagsabaran, Luzon Island, Philippines. METHODS: Following standard examination of femur gross anatomy and differential diagnosis of the hip joint fusion, ∼1 cm thick posterior midshaft femur samples were removed for microstructural examination. Using static histomorphometry, bone multi-cellular unit activity from Haversian canal (vascular pore) density, area, and circularity was reconstructed. Spatial positioning of Haversian canals was mapped using Geographic Information Systems software. Phosphate, carbonate, and carbonate:phosphate ratios were obtained using synchrotron-sourced Fourier transform infrared microspectroscopy. RESULTS: The left femur had greater cortical pore density, with smaller and rounder vascular canals, in addition to lower matrix levels of phosphate and carbonate, when compared to the right femur. CONCLUSIONS: Our data indicate compromised bone tissue in the left femur, and conform to expected bone functional adaptation paradigms of remodeling responses to pathological and biomechanical changes. SIGNIFICANCE: The preservation of this individual's hip abnormality created a unique opportunity to evaluate intra-skeletal bone health asymmetry, which may help other researchers evaluate the presence of limb disuse in archaeological samples. LIMITATIONS: A lack of lower limb data limits our interpretations to femur remodeling only. SUGGESTIONS FOR FURTHER RESEARCH: Future research efforts should aim to examine the presence of remodeling changes in all bones of the lower limb. LAYUNIN: Gamit ang buto ng magkabilang pemur ng isang taong natagpuan sa isang archaeological site na may sakit na ankylosis sa kaliwang balakang, pinag-aralan ang iba't-ibang microstructures galing sa gitnang bahagi o midshaft ng pemur upang malaman kung may makikitang mataas na cortical porosity ang buto dahil hindi ito malimit gamitin. GAMIT: Ang pinag-aaralang buto ay galing sa isang indibidwal na tinatayang middle-age na lalaki na namuhay noong Panahon ng Metal (∼2000 BP) sa Nagsabaran, Cagayan, Republika ng Pilipinas. PAMAMARAAN: Matapos ang unang pagkilatis sa femur at ang pagkilala ng sakit sa balakang, kumuha ng ∼1 sentimetro ng buto galing sa midshaft ng pemur upang lalong mapag-aralan ang kanyang microstructure. Gamit ang static histomorphometry, napag-aralan ang mga naiwang bakas ng multi-cellular unit activity ayon sa kapal, laki at pagkakabilog ng Haversian canal (vascular pore). Gumamit din ng Geographic Information Systems (GIS) software upang mapag-aralan ang kaugnayan ng posisyon ng Haversian canal. Panghuli, gumamit din ng synchroton-sourced Fourier transform infrared (sFTIR) microspectroscopy upang makuha ang bilang ng phosphate, carbonate, at carbonate:phosphate ratio. RESULTA: Napag-alaman na ang kaliwang pemur ay mayroong higit na maraming cortical pores, maliit at mabilog na vascular canals, at mababang bilang ng phosphate, carbonate kung ihahambing sa kanang pemur. KONKLUSYON: Ayon sa aming datos, ang kaliwang pemur ay umaayon sa mga katangian ng isang butong may sakit. Sumunod din ito sa inaasahang bone functional adaptation paradigms of remodeling ng buto dahil may sakit at hindi nagamit. KAHALAGAHAN: Dahil maganda ang pagkakalibing ng buto ng balakang, nagkaroon ng pagkakataong makilatis ang kalusugan ng sinaunang-tao sa pamamagitan ng pag-aaral ng kalusugan ng buto. Dagdag pa, makakatulong din ito upang malaman kung ibang mananaliksik ang pag-aaral ng ibang butong hindi nagagamit mula sa archaeological site. LIMITASYON: Dahil walang nakuhang ibang buto mula sa binti at paa, ang pemur lang ang naimbestigahan. MUNGKAHI PARA SA MGA SUSUNOD NA PAG-AARAL: Kung magkakaroon ng pagkakataon sa susunod, dapat maimbistigahan ang lahat ng buto ng binti (lower limb).

Ankylosis of a knee joint from Medieval London: Trauma, congenital anomaly or osteoarthritis?

OBJECTIVE: To explore the differential diagnoses of a fused left knee joint and the subsequent impairment. MATERIALS: An adult female skeleton from the Medieval cemetery of St Mary Spital (London, England). METHODS: We employed digital radiography and macroscopic observation to record the changes observed throughout the skeleton. We also used the Index of Care to explore the subsequent impairment. RESULTS: A range of congenital and developmental conditions were identified throughout the axial skeleton, with changes to the spine, pelvis, arms and leg bones reflecting adaptation to the mobility impairment. CONCLUSIONS: In all probability, the left knee reflects a case of congenital ankylosis with a differential diagnosis of subadult trauma. The female's skeleton had adapted to the impairment. Their risk is likely to have been elevated because of climatic and pandemic events during this period. SIGNIFICANCE: First reported case of congenital knee ankylosis. LIMITATIONS: The left knee joint was damaged during excavation. SUGGESTIONS FOR FURTHER RESEARCH: Additional imaging is advised.

Proximal interphalangeal joint ankylosis in an early medieval horse from Wroclaw Cathedral Island, Poland.

Animal remains that are unearthed during archaeological excavations often provide useful information about socio-cultural context, including human habits, beliefs, and ancestral relationships. In this report, we present pathologically altered equine first and second phalanges from an 11th century specimen that was excavated at Wroclaw Cathedral Island, Poland. The results of gross examination, radiography, and computed tomography, indicate osteoarthritis of the proximal interphalangeal joint, with partial ankylosis. Based on comparison with living modern horses undergoing lameness examination, as well as with recent literature, we conclude that the horse likely was lame for at least several months prior to death. The ability of this horse to work probably was reduced, but the degree of compromise during life cannot be stated precisely. Present day medical knowledge indicates that there was little likelihood of successful treatment for this condition during the middle ages. However, modern horses with similar pathology can function reasonably well with appropriate treatment and management, particularly following joint ankylosis. Thus, we approach the cultural question of why such an individual would have been maintained with limitations, for a probably-significant period of time.

Approach to the diagnosis of unusual carpal ankylosis from ancient Egypt.

OBJECTIVES: Carpal fusion is not an uncommon finding in archaeological bones. The majority of cases are due to inflammatory or infectious diseases and those are usually associated with other major alterations in the skeleton. METHODS: Two distinct individual cases, both adult females recovered from the Necropolis of Sharuna in the Middle Egypt from the Ptolemaic Period (IV to I BC) are presented in this study. Specimen 4323/1 shows a fusion of the scaphoid, lunate and triquetral bones in the right wrist. Specimen 4323/2 is a very rare fusion of a dysplastic lunate bone with the radius in the left wrist. In the proximal end of that left wrist, two possible remains of the flattened scaphoid and triquetral bones are also present. RESULTS: A differential diagnosis of both abnormalities as well as broad research into similar paleopathological cases were carried out: the most probable diagnosis for the specimen 4323/1 is an uncommon carpal coalition of three bones from the same row; the diagnosis of the specimen 4323/2 is more dubious with both rheumatoid arthritis and septic arthritis being strong candidates. CONCLUSIONS: In archaeological remains, carpal fusion should be thoroughly studied in order to ensure an accurate differential diagnosis.

John Rhea Barton: the birth of osteotomy.

Osteotomy is one of the most common surgical procedures performed everyday all over the world. This technique dates back to the first half of nineteenth century and to the fundamental contribution made by Pennsylvania Hospital surgeon John Rhea Barton (1794-1871), who can be considered the pioneer of modern osteotomies; this paper focuses on his life and career highlights with a description of the first corrective osteotomies for hip and knee ankylosis (documented in two fundamental papers whose original pictures are here reproduced). The success of osteotomy as a current surgical approach to treat several orthopaedic conditions is confirmation of the importance of this procedure in the orthopaedic discipline and prompted an investigation into the pioneering mind who introduced it.

Ankylosis of limb joints in a medieval cemetery from Bátmonostor, Hungary.

SUMMARY: Bony ankylosis of articulations is a rarely described alteration in the palaeopathological literature. This study presents 30 cases of ankylosis among 426 skeletons of the cemetery Bátmonostor (Southern Hungary) from middle ages. The material comprised four cases of knee, one case of hip, eight cases of tibio-fibularis joints and eight cases of metatarsals and tarsalia, two cases of malleolar joint, one case of wrist, four cases of sternoclavicularis, one case of carpo-metacarpal and one of radio-ulnar ankylosis. All individuals with joint fusion are adults, mostly between 41 and 60 years or over 60 at death. Two thirds of cases are male. The most interesting cases are briefly described.

[Cripples at the medieval hospital of Bátmonostor, Hungary--archeological findings]. / Egy magyarországi közepkori ispotály (Bátmonostor) beteganyaga az ásatási leletek tükrében.

Cripples from the medieval hospital of Bátmonostor, Hungary. People with disabilities were generally burdened with a painful fate in ancient times, however in the hospitals was no effective therapy. The hospital of Batmonostor was founded at late 13th century, The authors examine by morphological, radiological and histological methods 426 complete skeletons excavated from medieval (14th-15th century) cemetery of Bátmonostor (Hungary). Among them 30 cases (7.1%) of bony ankylosis, (24 cases on lower limb and 6 cases on upper limb) was found. Sacroiliac ankylosis 3 cases, Bechterew's spondylitis ankylopoetica 1 case was seen. Spondylitis tuberculosa and malum Potti 4 cases, and hunchback with other aetiology 2 cases was detected. Beside the cases with ankylosis severe posttraumatic osteomyelitis (7 cases), primary malignant bone tumors (2 cases) and an osteoplastic metastatic tumors (probably prostata carcinoma) was diagnosed. Paleopathologic study of the physically disabled may yield information and insight on the prevalence of crippling disorders. The authors hypothetize, that crippled persons lived in the hospital until their deaths.

Two cases of joint disease in post-medieval church cemetery of St. Ilija.

Evidence of disease was analyzed from the skeletal remains of 11 individuals dating to the post-Medieval period from church cemetery of St. Ilija in Serbia. Two individuals showed pathological condition affecting joints. It was supposed that first individual had been suffering from Legg-Calvé-Perthes disease. It seems that this condition remained untreated, with extensive bone remodeling, and that the deformity of femoral head and acetabulum caused secondary degenerative joint disease at a relatively early age of this individual. Second case was related to the bony akylosis of the hand finger, probably caused by Dupuytren's disease. In addition, we discussed development of differential diagnosis in both pathological conditions.

Etiopathogenesis of skeletal hyperostosis. A study of a European population that lived 7700 years ago.

The prevalence of hyperostosis meeting the criteria developed by Arlet and Mazières in skeletons from two of the oldest European necropolises of neolithic farmers was about 10%, i.e., similar to that in a medieval population of comparable demographic structure. This similarity over a greater than 6600-year period suggests that hyperostosis is related to genetic factors.

On the antiquity of the seronegative spondyloarthropathies: evidence from ancient Judea.

A fused pelvis and two specimens of fused vertebrae were found in an ossuary at Ein Gedi, Israel; they date from approximately 2000 years ago. Examination of these bony specimens visually and by computed tomography demonstrated features of the seronegative spondyloarthropathies.

[Source studies on the etiology, diagnosis and treatment of TMJ ankylosis and syngnathia. 1. From classical antiquity to mid-19th century]. / Quellenstudien zur Atiologie, Diagnose und Therapie der Kiefergelenksankylose und Syngnathie. 1: Von der klassischen Antike bis zur Mitte des 19. Jahrhunderts.

The present first part of two of a historical overview on ankylosis of the TMJ and syngnathia covers the period from antiquity to the 2nd half of 19th century. Etiology, case studies and the first therapeutic approaches are documented on the basis of long forgotten and meanwhile hardly accessible original sources.