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Hernigou P, Hosny GA, Scarlat M. Evolution of orthopaedic diseases through four thousand three hundred years: from ancient Egypt with virtual examinations of mummies to the twenty-first century. INTERNATIONAL ORTHOPAEDICS 2024; 48:865-884. [PMID: 37867166 DOI: 10.1007/s00264-023-06012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE This study conducts a comprehensive comparative analysis of bone pathologies between ancient Egypt and today. We aim to elucidate the prevalence, types, and potential aetiological factors influencing skeletal disorders in these two distinct temporal and cultural contexts. METHODS The research employs a multidisciplinary approach, integrating osteological, paleopathological, and historical data to understand bone pathologies in mummies and the actual world. Applying radiographs and CT scans as noninvasive techniques has shed new light on past diseases such as fractures, dysplasia, osteoarthritis, surgery, and tuberculosis. Virtual inspection has almost replaced classical autopsy and is essential, especially when dealing with museum specimens. RESULTS Findings indicate no significant disparities in the prevalence and types of bone pathologies through 4300 years of evolution. Moreover, this study sheds light on the impact of sociocultural factors on bone health. Examination of ancient Egypt's burial practices and associated cultural beliefs provides insights into potential behavioral and ritualistic influences on bone pathologies and the prevalence of specific pathologies in the past and present. CONCLUSION This comparative analysis illuminates the dynamic of bone pathologies, highlighting the interplay of biological, cultural, and environmental factors. By synthesizing archeological and clinical data, this research contributes to a more nuanced understanding of skeletal health's complexities in ancient and modern societies, offering valuable insights for anthropological and clinical disciplines.
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Affiliation(s)
| | | | - Marius Scarlat
- Clinique Chirurgicale St Michel, Groupe ELSAN, Toulon, France
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Loder RT, Buzon MR, Sanders KE. A Healed Intertrochanteric Femur Fracture, Shoulder, and Rib Fractures in an Ancient Nubian Female: An Osteoarchaeological Perspective. ScientificWorldJournal 2024; 2024:8339694. [PMID: 38375132 PMCID: PMC10876308 DOI: 10.1155/2024/8339694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
This report is a case of a healed proximal intertrochanteric femur fracture nonunion in an ancient Nubian adult female, approximately 58 years old at the time of death, from the Tombos archaeological site in present day northern Sudan. Tombos was founded as an Egyptian colonial town during the New Kingdom Period (14001070 BC). The individual was radiocarbon dated to 1114-910 BC and also exhibited healed fractures of the left proximal humerus and ribs. There was shortening and mild atrophy of the right femur compared to the left; radiographs demonstrated a varus deformity of the proximal femur with associated retroversion. Bone density analysis revealed that the tissue mineral density z-score for this individual was -0.798, with the z-score for Tombos females 15-24 years old being 0.396, or a total difference of 1.194. This indicates that the individual was osteopenic but not osteoporotic prior to demise. This is an important case as it occurred approximately 3000 years ago and is the oldest known reported case of a healed intertrochanteric hip fracture in the archaeological literature. Archaeological cases of intertrochanteric hip fractures are rare, with none previously reported from the BC era. The timing of these multiple fractures is unknown, but all healed before the demise of the individual. Thus, there must have been considerable care afforded to such an individual to minimize the morbidities associated with nonoperative care of such a fracture. If all these fractures occurred at the same time due to a traumatic, accidental injury, the Modified Injury Severity Score (MISS) would be 25. Modern day trauma resuscitation and orthopaedic care gives an estimated mortality for such a MISS score of 28% for those <50 years old. It is likely that this individual's high socioeconomic status allowed for intensive nursing care which likely decreased the morality risk.
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Affiliation(s)
- Randall T. Loder
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michele R. Buzon
- Department of Anthropology, Purdue University, West Lafayette, IN, USA
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Myszka A, Mańkowska-Pliszka H, Rzeźnicka E, Dąbkowska A, Tomczyk J. Case study of Legg-Calvé-Perthes disease observed in Radom (Poland, 18th–19th century) with literature review. ANTHROPOLOGICAL REVIEW 2023. [DOI: 10.18778/1898-6773.86.1.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
The aim of this study is to present the pathological lesions observed in a skeleton (male, about 35–38 years old) from Radom (Poland), dated to the 18th–19th century. Bone changes were observed in both femurs and both pelvic bones. The head of the femur is enlarged and deformed, described as “mushroom-shaped”, with areas of smooth cortex and cavities, or possible cystic residues. The neck of femur is short and thick. The bone shaft and distal epiphysis do not show any changes. The changes were also observed in both acetabularies of the hip joint (marginal bone formation, subchondral bone remodelling). Radiographic images show bilateral necrosis of the femoral head. There is a significant sclerotization of the femoral head, with a discrete visible crescent sign. These macroscopic and radiological changes match the symptoms associated with Legg-Calvé-Perthes disease. This is the first case of the disease described in bioarchaeological materials from Poland.
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Guimarey Duarte R, Rubio Salvador Á, Alemán Aguilera I, Botella López MC. Two cases of pelvic trauma with survival in the necropolis of Qubbet el-Hawa (Egypt). INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2023; 40:56-62. [PMID: 36543051 DOI: 10.1016/j.ijpp.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/27/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To evaluate the presence of a trauma that results in pelvic ring disruption and its clinical implications in two individuals from ancient Egypt. MATERIALS Two complete skeletons of adult women, dated to the Middle Kingdom (c. 1980-1760 BCE), from two tombs in the necropolis of Qubbet el-Hawa (Aswan, Egypt). METHODS The anatomical elements were examined macroscopically in Egypt. RESULTS Unilateral sacroiliac luxation with disruption of the pubic symphysis was detected in both individuals. The presence of an overlapped symphysis was evident in female QH34aa. A healed fracture of the iliopubic ramus are present in female QH122. Antemortem bone alterations in the pelvis demonstrate that they survived the trauma. CONCLUSIONS Pelvic trauma due to a lateral compression was detected in the os coxae. Both women survived but probably had severe sequelae that impaired their quality of life. At least one of them might have received some type of medical treatment. SIGNIFICANCE Both cases shed light on pelvic fractures, their mechanisms of production, and their effects on bone and its functionality, as well as revealing possible associated lesions of soft tissues and vital organs. LIMITATIONS The pelvis, or at least the pubic symphysis, must be well preserved to allow the correct diagnosis of this type of lesion. SUGGESTIONS FOR FURTHER RESEARCH Studies are warranted on the detection of this type of fracture, focusing on the subtle bone changes that indicate its presence. There is also a need to develop methodologies that combine the study of bone and soft tissue alterations.
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Affiliation(s)
- Rosario Guimarey Duarte
- Laboratory of Anthropology, Department of Legal Medicine, Toxicology and Physical Anthropology, Faculty of Medicine, University of Granada, Av. de la Investigación 11, 18016 Granada, Spain.
| | - Ángel Rubio Salvador
- Laboratory of Anthropology, Department of Legal Medicine, Toxicology and Physical Anthropology, Faculty of Medicine, University of Granada, Av. de la Investigación 11, 18016 Granada, Spain; Department of Anthropology, Geography and History, Faculty of Humanities and Educational Sciences, University of Jaén, Campus de las Lagunillas s/n, 23071 Jaén, Spain
| | - Inmaculada Alemán Aguilera
- Laboratory of Anthropology, Department of Legal Medicine, Toxicology and Physical Anthropology, Faculty of Medicine, University of Granada, Av. de la Investigación 11, 18016 Granada, Spain
| | - Miguel C Botella López
- Laboratory of Anthropology, Department of Legal Medicine, Toxicology and Physical Anthropology, Faculty of Medicine, University of Granada, Av. de la Investigación 11, 18016 Granada, Spain
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Rossano A, Manohar N, Veenendaal WJ, van den Bekerom MP, Ring D, Fatehi A. Prevalence of acromioclavicular joint osteoarthritis in people not seeking care: A systematic review. J Orthop 2022; 32:85-91. [DOI: 10.1016/j.jor.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/27/2022] Open
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Kim HJ. Health insurance policy on surgical treatment of adult spinal deformity. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.11.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Recent burgeoning research on adult spinal deformity (ASD) has unveiled the benefits of surgical treatment and how to gain the benefits although these have only been around for 10 years.Current Concepts: During the last decade, the significance of pelvic incidence in the global spinal sagittal alignment and introductions of the Scoliosis Research Society-Schwab classification for ASD have been the guidelines of surgical treatment for ASD and the milestones for promising surgical results. However, one of the unsolved problems for the surgical treatment of ASD is the proximal junctional kyphosis, for which multifactorial causative factors have been suggested. Recent studies have focused on dynamic natures in patients with ASD during daily activities, which might be a clue for both prevention of proximal junctional kyphosis and a better level of surgical results. Even though a recent remarkable advancement for surgical treatment for ASD is present, the national guideline for reimbursement is still following the surgical indication for lumbar degenerative kyphosis published in 1988.Discussion and Conclusion: A significant gap exists between the national reimbursement guideline and generally held surgical indication for ASD surgery. Consequently, this huge gap raises trouble in both patients and surgeons. The patients with ASD cannot take an appropriate surgery for ASD, while the spine surgeons experience unreasonable adjustment of the cost by the Health Insurance Review and Assessment Service.
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Panzer S, Augat P, Sprenger M, Zesch S, Rosendahl W, Sutherland ML, Thompson RC, Paladin A, Zink AR. Correlation of atherosclerosis and osteoarthritis in ancient Egypt: A standardized evaluation of 45 whole-body CT examinations. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2021; 33:137-145. [PMID: 33930634 DOI: 10.1016/j.ijpp.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/01/2021] [Accepted: 04/04/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To correlate atherosclerosis (Ath) and osteoarthritis (OA) in mummies from ancient Egypt. MATERIALS Whole-body CT examinations of 23 mummies from the Ägyptisches Museum und Papyrussammlung, Berlin, Germany, and 22 mummies from the Museo Egizio, Turin, Italy. METHODS Ath was assessed in five anatomical regions by means of preserved arterial calcifications. OA was assessed using the Kellgren and Lawrence (1957) classification. RESULTS Statistical analysis revealed no correlation between Ath and total OA. A significant association was found for Ath and the upper limb group for OA grade >1 and for Ath and the lower limb group, consisting mainly of the hip and knee, for OA grade >2 OA. CONCLUSIONS The association of Ath and advanced OA of the hip and knee is comparable in prevalence to those reported in recent clinical studies, despite the low life expectancy and the different environment and lifestyle of the ancient Egyptians. SIGNIFICANCE This is the first study to correlate findings of Ath and OA in ancient Egypt statistically. The diseases of Ath and OA are common ailments with enormous and increasing impacts on public health. LIMITATIONS The large number of cardiovascular diseases was indicated only by arterial calcifications that resisted the post-mortem changes of the mummification process. Also, the assessed OA was on radiological OA. SUGGESTIONS FOR FURTHER RESEARCH Genomic studies of ancient Egyptian mummies may reveal genetic risk factors for Ath and OA that could be shared in ancient and modern populations.
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Affiliation(s)
- Stephanie Panzer
- Department of Radiology, Berufsgenossenschaftliche Unfallklinik Murnau, Prof-Küntscher-Strasse 8, D-82418 Murnau, Germany; Institute of Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau and Paracelsus Medical University, Salzburg, Austria, Prof-Küntscher-Strasse 8, D-82418 Murnau, Germany.
| | - Peter Augat
- Institute of Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau and Paracelsus Medical University, Salzburg, Austria, Prof-Küntscher-Strasse 8, D-82418 Murnau, Germany.
| | - Martin Sprenger
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsplatz 4/3, A-8010 Graz, Austria.
| | - Stephanie Zesch
- German Mummy Project, Reiss-Engelhorn-Museen Mannheim, Zeughaus C5, D-68159 Mannheim, Germany.
| | - Wilfried Rosendahl
- German Mummy Project, Reiss-Engelhorn-Museen Mannheim, Zeughaus C5, D-68159 Mannheim, Germany.
| | - M Linda Sutherland
- MemorialCare Health Systems, 18035 Brookhurst St, Fountain Valley, California, USA.
| | - Randall C Thompson
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, 4330 Wornall Road, Kansas City, MO 6411, USA.
| | - Alice Paladin
- Institute for Mummy Studies, Eurac Research, Viale Druso 1, I-39100 Bolzano, Italy.
| | - Albert R Zink
- Institute for Mummy Studies, Eurac Research, Viale Druso 1, I-39100 Bolzano, Italy.
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Fuchs K, Atabiev BC, Witzmann F, Gresky J. Towards a definition of Ancient Rare Diseases (ARD): Presenting a complex case of probable Legg-Calvé-Perthes Disease from the North Caucasian Bronze Age (2200-1650 cal BCE). INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2021; 32:61-73. [PMID: 33360164 DOI: 10.1016/j.ijpp.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study discusses the challenges and possibilities of establishing a definition for Ancient Rare Diseases (ARD) in a probable case of Legg-Calvé-Perthes Disease (LCPD) from the Bronze Age cemetery Kudachurt 14, situated in the Northern Caucasus. MATERIALS We investigated the skeletal remains of a male aged 35-45 years at death. For comparison we examined other males buried at Kudachurt 14 (n = 24) and reviewed 22 LCPD cases from the paleopathological literature. METHODS We use macroscopic as well as osteometric examination methods and imaging techniques. RESULTS The morphology of the left hip joint corresponds to skeletal characteristics for LCPD. Co-occurring osteochondrosis dissecans, femoral anteversion, and atrophy of the left femoral shaft suggest a complex disease course. CONCLUSIONS Modern criteria of rare diseases applied on ancient skeletal remains are either non-transferable or require completion. We conclude that rarity is dynamic, etiological uncertainty has to be accepted, and the respective socioeconomic context is crucial. Degree of disability and level of sociomedical investment are not defining criteria for ARD. SIGNIFICANCE Dating 2200-1650 cal BCE, this study currently presents the earliest case of probable LCPD. This is the first attempt to transform modern characteristics of rare diseases for establishing a paleopathological concept of ARD. LIMITATIONS As this study is limited to LCPD, our conclusions are not directly applicable to other ARD in question. SUGGESTIONS FOR FURTHER RESEARCH More focused paleopathological research on skeletal populations from different cultures and time periods is needed, enabling an evolutionary perspective on the comparability of ancient, modern and future rare diseases.
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Affiliation(s)
- Katharina Fuchs
- Institute of Clinical Molecular Biology, Kiel University, Rosalind-Franklin-Str. 12, 24105, Kiel, Germany.
| | - Biaslan Ch Atabiev
- Institute of Caucasian Archaeology, Kathkanova 30, 361401, Nalchik, Republic Kabardino-Balkaria, Russian Federation.
| | - Florian Witzmann
- Museum für Naturkunde, Leibniz Institute for Evolution and Biodiversity Science, Berlin, Germany.
| | - Julia Gresky
- German Archaeological Institute, Department of Natural Sciences, Im Dol 2-6, 14195, Berlin, Germany.
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Licata M, Tosi A, Larentis O, Rossetti C, Lorio S, Pinto A. Radiology of Mummies. Semin Ultrasound CT MR 2019; 40:5-11. [PMID: 30686367 DOI: 10.1053/j.sult.2018.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In the past, autoptic examinations were usually performed for research. This type of examination, for obvious reasons, did not appeal to paleopathologists as these procedures potentially damaged the finds destined to musealization. Since the discovery of X-ray, radiology has been used to study mummies as a noninvasive technique. The radiology of mummies allows us to discover pathologies, to elaborate on the type of ritual mummification for the artificial embalming, to comprehend the diagenetic process that guaranteed a natural mummification, or to conclude anthropological identification. We present a review on the latest studies on mummies that have shown that the radiological approach has been essential to conduct research.
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Affiliation(s)
- Marta Licata
- Department of Biotechnology and Life Sciences, Centre of Research in Osteoarchaeology and Paleopathology, University of Insubria, Varese, Italy.
| | - Adelaide Tosi
- Department of Biotechnology and Life Sciences, Centre of Research in Osteoarchaeology and Paleopathology, University of Insubria, Varese, Italy
| | - Omar Larentis
- Department of Biotechnology and Life Sciences, Centre of Research in Osteoarchaeology and Paleopathology, University of Insubria, Varese, Italy
| | - Chiara Rossetti
- Department of Biotechnology and Life Sciences, Centre of Research in Osteoarchaeology and Paleopathology, University of Insubria, Varese, Italy
| | - Silvia Lorio
- Department of Molecular Medicine, Unit of History of Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonio Pinto
- Department of Radiology, CTO Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
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Monge JM, Rühli F. The anatomy of the mummy: mortui viventes docent--when ancient mummies speak to modern doctors. Anat Rec (Hoboken) 2016; 298:935-40. [PMID: 25998629 DOI: 10.1002/ar.23129] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 01/30/2015] [Indexed: 02/07/2023]
Abstract
There is almost a universal fascination with prehistoric, protohistoric, and historic human remains that preserve the soft tissues (nonskeletal) of the body (general definition of a mummy). While most people within the general public engage with mummies as part of a museum exhibit process, many scientists have taken that fascination much further. Starting as a general fascination with mummification, the scientific process involved in the study of mummies began in earnest in the late 18th Century AD. This issue of the Anatomical Record was conceived and formulated to bring together a series of researchers to highlight their most groundbreaking research on the scientific advances that surround the 21st Century AD study of these preserved biological beings including an illumination of the cultural processes that purposefully or inadvertently are preserved either within their tissues or are present within the context (archaeological) in which they are found (excavated). Twenty-six research articles are presented in this volume on a variety of topics all related to the rich transdisciplinary fields that are now directing their research efforts to the state-of-the art analysis of human mummified remains.
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Affiliation(s)
- Janet M Monge
- University of Pennsylvania Museum of Archaeology and Anthropology, Philadelphia, Pennsylvania
| | - Frank Rühli
- Swiss Mummy Project, Centre for Evolutionary Medicine, Institute of Anatomy, University of Zurich, Zurich, Switzerland
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