Infective and metabolic disease

Abstract

The skeleton, attributable to a senile male subject, is well built, but the bone sections have not been particularly modified by bio-mechanical stress. The horizontal cranial index suggests mesocrania (not particularly elongated shape of the skull), the frontal crests are averagely diverging, and the forehead is broad (eurymetopic). Two Wormian bones can be seen on the skull along the lambdoid suture, and some sessile exostoses are at the external auditory meatus (Fig. 6.1); these ossifications seem to be connected to a prolonged, frequent soak in cold water [1], even though many authors are inclined to think of a multifactorial aetiology [2]. As for the dento-alveolar complex, there is a large abscess cavity in correspondence with the alveoli of the first mandibular incisors (Fig. 6.2), which were lost intra-vitam; the first left molar and the second right molar are characterized, respectively, by a cavity in the tooth pulp and one in the dentine, and they both show the consequence of odontogenic abscesses on the alveolar processes. The left maxilla shows the loss of the three molars intra-vitam (the right one cannot be seen). A probable dislocation can be seen at the left temporo-mandibular joint (Fig. 6.3), with reshaping of the edge of the glenoid fossa and formation of a bone ring on the antero-superior margin of the mandibular condyle. At the insertion of the conoid and trapezoid ligaments and at the origin of the deltoid muscle on the clavicles, there are some evident enthesopatic modifications of ostheophytic nature, likely resulting from repeated shoulder movements; moreover, the enthesopathy at the insertion of the infraspinatus muscle of the right humerus confirms a frequent rotation of the humerus on the scapula. The diaphyseal index, and the enthesopathies on the interosseous tubercles of the radial bones, shows a protruding interosseous crest, which suggest habitual forearm movements of pronation and supination; this hypothesis is also corroborated by the marked development of the attachment area of the pronator quadratus muscle of the ulnas. The flattening of the lesser trochanter, where the iliopsoas muscle is inserted, and the presence of the facet of Poirier on the femurs suggest a major flexion and abduction of the thigh; on the other hand, the enthesopathies at the origin of the tibial soleus muscle, at the insertion of the Achilles tendon and at the insertion of the plantar ligament would suggest habitual extension movements of the foot and prolonged marching on broken ground. The surfaces and the articular outline of most bone epiphyses of the appendicular skeleton are well worn, with diffused porosities and formation of bone rings. In particular, the right elbow joint is characterized by the formation of sclerotic bone plaques, at the humerus olecranon fossa and of the ulnar semilunar incisure; on the humerus condyle, an area of smooth compact bone can be seen, similar to ivory (eburnation), and the ulnar coronoid process is deformed, with expanded and jagged margins. These variations suggest diffused suffering of the joint cartilages, and their aetiology probably results from gout. The outer face of the ilium shows a new bone formation in the insertion area of the abdominal external oblique muscle (calcar crest) [3], while the attachment area of the reflexed tendon of the rectus femoris muscle is hypertrophic. A defect in the acetabulum fusion can be seen as a U-shaped notch, on the superior part of the acetabular fossa; this anomaly can be considered as a non-metric trait of almost no pathological value. As for the rachis, exuberant sindesmophytes are localized on the superior and inferior margins of the vertebral bodies; in T9-T10, the bone protuberances are linked and form a bony bridge between the two vertebrae, with a resulting ankylosis (Fig. 6.4). The fifth lumbar vertebra shows the imprint of an intraspongious hernia on the superior endplate. The costo-sternal cartilages are completely ossified, with a considerable deformity of the sternal margin.