Upload
hatruc
View
214
Download
2
Embed Size (px)
Citation preview
RESEARCH POSTER PRESENTATION DESIGN © 2012
www.PosterPresentations.com
• Avascular necrosis is the death of bone tissue stemming from
an interrupted blood supply from a variety of causes.
• Since many conditions are rare archaeologically,
understanding probable causes for this pathological skeleton
adds to our understanding of health and disease in the past.
• Here, we undertake a differential diagnosis focusing on
neck-shaft angulation in order to suggest a possible
etiology for this condition in a pathological individual
from the Campbell site, Missouri.
• Affected areas were centered around joints: right hip, right
shoulder, right elbow, and left wrist. The skull, mandible,
and tibae were not affected.
Os Coxa:
• Right os coxa has a smooth reactive area around the glenoid
labrum, and the acetabular notch has a porous, reactive area
showing the underlying trabeculae with no clear border. The
lunate fossa also has smoothed pits.
Femur:
• Right femoral head has no clear fovea capitis. Instead, the
location has remodeled areas with osteoblastic and ostelytic
activity.
• Femoral head is “mushroomed” out and has smooth lipping
on the edges. There is a femoral neck present, but the axis of
the head is posterior-inferior.
• The greater trochanter appears normal but there is
taphonomic damage to the cortical surface.
• The lesser trochanter has a wear facet that is flattened,
enlarged, and extends medially. There is no 3rd trochanter,
Allen’s facet, or Poirier’s facet. The adductor tubercle is
enlarged.
Site Background
Humeri:
• Right humerus is shortened compared to the unaffected left
humerus. Head is small, flattened, and distally displaced.
One, possibly two lytic defects on the medio-distal surface of
the head. No anatomical neck can be discerned.
• Right humeral diaphysis exhibits pronounced lateral bowing
with an enlarged deltoid tuberosity.
• Right distal trochlea has evidence of remodeling on the
medial aspect. There is pronounced lipping on the lateral side,
with a groove in the center of the anterior trochlea. Anterior
capitulum shows evidence of remodeling.
Affected Elements
• Femoral torsion and NSA were compared to literature values
published for plausible hip pathologies, and compared to
Campbell for population-specific differences.
Conclusions
References
AcknowledgementsThe authors would like to thank the Museum of Anthropology-University of Missouri,
Candace Sall, and Jessica Boldt for their assistance in accessing the Campbell skeletal
remains.
• A skeletal abnormality was located in collection from the
Campbell site (23PM5) in Pemiscot County, MO.
• The site was dated to the Late Mississippian period (1540-
1650 A.D.) by pottery and biological similarities to other
Nodena-phase sites from Arkansas.
• Site was discovered by surface collections in 1954 and
surveyed and documented over 15 years.
• The population was maize-reliant with a relatively light
disease load and marked behavioral dimorphism. The life
expectancy is relatively high compared to other sites of this
period1.
Department of Anthropology, University of Missouri
• 23PM5.54 had a significantly lower NSA than the Campbell
distribution (p>0.001) due to the head displacement.
• 23PM5.54 was anteverted, but not significantly different
than the Campbell distribution (p=0.936), which is highly
anteverted compared to modern populations.
• NSA suggests that 23PM5.54 falls within the pattern of
SCFE and LCPD.
• Version is inconclusive compared to the examined
pathological conditions.
Rob’yn A. Johnston, Stephanie L. Child, Libby W. Cowgill
A multi-joint case of avascular necrosis in a prehistoric Native American female
Ulna:
• Right ulna has an osteophytic projection that appears to limit
full extension of the elbow. A groove is present where the
olecranon fuses to the proximal ulna. A wear facet is present
distal to the radial fossa, suggesting that the radius had been
inferiorly displaced.
Radius:
• Left distal radial articular surface has been completely
obliterated by osteoblastic activity. The ulnar fossa cannot be
determined, and osteophyte development has caused extreme
lipping, flattening, and grooving of the joint surface. Materials and Methods
• 23PM5.54: female, based on pelvic morphology; age 41-45
based on dental eruption and pubic symphysis
Elements present:
• Complete skull and mandible
• Humeri: right and left, complete.
• Radius: proximal right, distal left
• Ulna: proximal right, proximal and distal fragments
of left
• Sacrum: mostly complete
• Os Coxa: complete left and right
• Femora: complete right
• Tibiae: complete right and left
• Fibula: left distal
Elements missing:
• All vertebrae and ribs
• Sternum
• Left femur
• Right fibula
• Both clavicles
• Both scapulae
• Both patellae
• All bones of hands, wrists, feet, and ankles.
• Missing elements are most likely due to the salvage nature of
the collection. Crania, pelvises, and long bones were
preferentially collected, as were right side elements.
• Population estimates of torsion and neck shaft angles (NSA)
were determined for all individuals in the Campbell site for
comparison.
• 23PM5.54 was also compared to literature values for possible
pathological conditions (developmental dysplasia of hip,
slipped capital femoral epiphyses, Legg-Calve-Perthes
disease).
• Differential diagnosis was performed to discriminate among
possible pathological conditions.
Affected Elements cont.
Condition NSA VersionFemoral qualitative
features
Typical
125⁰(SD
5.3⁰)15-20⁰ -
Developmental
dysplasia of the hip
Coxa
valgaAnteverted
Underdeveloped
femoral head,
flattening (late stage).
Short, thin neck.2
Slipped capital
femoral epiphysis
(SCFE)
Coxa
vara
Retroverted
(1-2.5⁰)
Fracture on femoral
neck, lack of femoral
neck, mushrooming
(late stage)
Legg-Calve-Perthes
disease (LCPD)
Coxa
vara
Anteverted
(>20⁰)
“Mushroom-like”
femoral head, lack of
fovea capitis
Results
• NSA suggests 23PM5.54 is more consistent with SCFE or
LCPD. Version is inconclusive, but the lack of retroversion
suggests LCPD is more probable than SCFE.
• Since multiple joints were affected, this suggests 23PM5.54
was affected by systemic avascular necrosis of unknown
etiology rather than trauma or a developmental condition.
• While the pathological condition cannot be determined with
certainty, we believe that LCPD is the most probable
condition. Because this condition is uncommon in Native
Americans3 and less common in females (25% of cases), this
would make it a unique instance of this disease.
• Future directions include radiographic analyses to examine
neck thickness and trabecular orientation.
Tibae and Fibulae:
• Tibae and partial fibulae appear normal except for site-wide
pathology such as periostosis (18.7% of individuals affected)1.
1Holland, Thomas D. An archaeological and biological analysis of the Campbell Site.
Diss. University of Missouri-Columbia, 1991.
2Mitchell, P. D., and R. C. Redfern. "Diagnostic criteria for developmental dislocation of
the hip in human skeletal remains." International Journal of Osteoarchaeology 18.1
(2008): 61-71.
3Roy, Dennis R. "Current concepts in Legg-Calve-Perthes disease." Pediatric
annals 28.12 (1999): 748-752.
Figure 1: Proximal right femur anterior view (left) and posterior view (right).
Figure 2: Proximal anterior (left) and distal posterior (right) views of the humeri.
Figure 2: Proximal ulnae.
Note pathological
differences on right ulna
(left side).
Figure 3: Distal left
radius. Note remodeling
of the distal articular
surface.
Table 1: Features used for differential diagnosis.
Figure 4: Campbell mean NSA (left) versus 23PM5.54 NSA (right)
Figure 5: Campbell mean version (left) versus 23PM5.54 version (right)
Introduction
Differential Diagnosis