A slipped capital femoral epiphysis case study from medieval Estremoz, Portugal *
[email protected]
Ana Curto*1, Teresa Fernandes1,2
1Universidade
de Évora
2CIAS
Abstract Slipped capital femoral epiphysis is the result of a fracture at the growth plate of the femoral head. In this study we describe an adult male skeleton from a medieval necropolis in Estremoz, Portugal, in which we observed a misalignment of the left femoral head leading to the shortening of the neck. This condition resulted in an enlargement of the femoral head and probably leads to osteoarthritis in both the femoral head and the acetabulum.
Key words Introduction Slipped capital femoral epiphysis (SCFE) is the result of a fracture at the growth plate of the femoral head that happens most frequently between the age of 10 and 17 years and although it might have some genetic influence, trauma, the adolescent growth spurt and obesity may be contributing factors [1,2,3].
(A) Figure 1 Left proximal femur. (A) Posterior view. (B) Radiograph of antero-posterior view.
Paleopathology, developmental disorder, trauma, osteoarthritis
Both the maximum and the physiological length of this individual are bellow the mean registered for this sample (Table 1). However, for the femoral head diameter we observed the opposite, even in the right (non pathological) femur. This can be due to the mechanical pressure on the right femur, although it doesn’t look more robust than the left femur.
Figure 2 Left and right proximal femora. Left femur with enlarged femoral head, osteoarthritis and tortion .
Table 1 Femora measurements registered for RMPE-69 and male sample from the same necropolis.
Femur measurements (cm) Maximum length
Material and Methods The skeleton (RMPE-69) described in this work was exhumed from a medieval necropolis (13th to 15th centuries) in Rossio Marquês de Pombal, Estremoz, SE Portugal. From this burial ground there were recovered 66 skeletons, from which 60 were adults, 19 diagnosed as female and 39 as male. All lesions were observed and registered macroscopically and when relevant we used radiographies to aid us during the differential diagnosis, as well as measurements from the femora.
Results and Discussion The skeleton RMPE-69 was diagnosed as an adult male [4] between 40 and 44 years old [5]. In the left femur of this individual we observed a misalignment of the femoral head leading to: • shortening of the neck and the femur itself (Table 1), being 11cm shorter than the physiological length registered for the right femur; • posteriorly and medially displacement of the epiphysis with a reduction in the anteroposterior neckshaft angle, resulting in an enlargement of the femoral head (Fig. 1); • osteoarthritis in both the femoral head (Figure 2) and the acetabulum (Figure 3) showing porosity, lipping and eburnation; • asymmetrical mesio-distal tortion of the left femur (Fig. 2).
Femoral head diameter
Right
Left
Right
Left
Right
Left
430,00
425,00
428,00
417,00
48,91
56,19
Mean 443,05 N 21
441,95 19
438,14 21
438,05 19
46,21 22
45,70 21
RMPE-69 RMPE ♂
Physiological length
Minimum 497,00
490,00
486,00
486,00
51,38
51,91
Maximum 392,00
392,00
390,00
390,00
41,32
41,37
Besides the lesions compatible with SCFE, this skeleton also has vertebral degenerative arthritis changes, especially in the lumbar region but also in the cervical and thoracic regions that may be related with the individual’s locomotion, as the vertebral column compensated for a shortened limb. The knee and foot did not show osteoarthritic changes and there are no lesions related with SCFE or osteoarthritis at the right lower member. A remodelled tear shape trauma (27,17x14,99 mm) at the right parietal (Fig. 4) was also observed, although it doesn’t seem related with SCFE. Due to the lesions described above we can exclude pathologies such as tuberculosis of the hip or Legg-Calvé-Perthes disease once both of them don’t involve slippage of the femoral head [1,2]. Since the remainder skeleton doesn’t show similar lesions we can exclude a case of rickets and it probably isn’t a congenital dislocation of the hip because this condition creates a new joint for the femoral head [1,2], which isn’t present in this case study. Although the lesions observed in this skeleton are compatible with SCFE we can’t exclude other pathologies such as fracture of the hip. For this reason, and according with the Modified Istanbul Protocol [6] we consider this case a typical case of SCFE.
Figure 3 Left acetabulum with osteoarthritis.
Figure 4 Cranium with traumatic lesion at the right parietal.
Literature cited: [1] Aufderheide, A. C.; Rodríguez-Martín, C. 1998. The Cambridge encyclopedia of human paleopathology. Cambridge, Cambridge University Press. [2] Ortner, D.J. 2003. Identification of pathological conditions in human skeletal remains. London: Academic Press. [3] Waldron, T. 2009. Paleopathology. Cambridge, Cambridge University Press. [4] Bruzek, J. 2002. A method for visual determination of sex, using the human hip bone. American Journal of Physical Anthropology, 117: 157-168. [5] Lovejoy, C. O.; Meindl, R. S.; Pryzbeck T. R.; Mensforth, R. P. 1985. Chronological metamorphosis of the auricular surface of the ilium: a new method for the determination of adult skeletal age at death. American Journal of Physical Anthropology, 68: 15-28. [6] Appleby, J.; Thomas, R.; Buikstra, J. 2015. Increasing confidence in paleopathological diagnosis – Application of the Istanbul terminological framework. International Journal of Paleopathology, 8: 19-21.
