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• 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