Paola Saccheri

Bilateral arcuate foramen associated with partial defect of the posterior arch of the atlas in a medieval skeleton: case report and review of the literature. Looking backward to go forward

PurposeWe observed a complex atlas (C1) dysmorphism in a human medieval skeleton dug up from the sixth to the seventh century necropolis located in the north-eastern Italy. We analyzed such a dysmorphism in the light of pertinent literature and discussed the functional and clinical implications related to this type of C1 structural malformation.MethodsMacroscopical and CT-SCAN examinations of the atlas were carried out.ResultsBone findings consisted of partial aplasia of the posterior arch of the C1 accompanied by a bilateral arcuate foramen. In addition, the spinous processes of C7 and T1 were found to be bifid.ConclusionsAlthough such abnormalities are supposed to be clinically inconspicuous, yet they may become challenging or even dangerous in the context of trauma. They may even complicate specific diagnostic or surgical procedures. In addition, they may cause a great number of symptoms, ranging from headache and neck pain to loss of postural muscle tone and consciousness, due to the close and complex relationship of bone structures with nerves, blood vessels, muscles, and ligaments. As a result, radiologists, clinicians, surgeons, and chiropractors should consider in their clinical reasoning the possibility that atlas dysmorphisms may occur.

A keyhole-shaped sternal defect in an ancient human skeleton

We observed a sternal foramen contiguous with a small sternal cleft in a human skeleton coming from North-Eastern Italy and dating back to between the sixteenth and seventeenth century AD. Both of these types of anomalies result from a defective midline fusion of the developing sternum. Sternal foramen is a relatively common bony defect that usually comes to light as an incidental finding. Sternal cleft is a rarer morphological anomaly that can have a wide spectrum of clinical manifestations and outcomes, depending on the extent of the bony defect as well as on the presence and severity of other abnormalities. The coexistence of a sternal foramen and a sternal cleft has very rarely been described in the literature. We report here one such unusual association and discuss its potential practical implications. In most cases, sternal foramina and small sternal clefts are clinically uneventful; yet, lack of awareness about the existence of these subtle anatomical variations can sometimes lead to misinterpretation of radiological and pathological findings or make sternal biopsy and acupuncture unsafe.

Unusual case of occipital vertebra in a medieval skeleton.

The craniovertebral junction (CVJ) is a transitional region of the spine that exhibits extensive structural variability. Developmental defects include a vast array of anatomical anomalies that result, from remnants of the proatlas and are grouped under the term ‘occipital vertebra’. The purpose of the present paper is to describe the case of a medieval skeleton, which was found to display a previously unreported manifestation of occipital vertebra. It consisted of two large basilar processes that articulated with the anterior arch of the atlas. In addition, the left process exhibited a supplementary contact zone with the dens of the axis. These structural defects were associated with an accessory canal situated posterior to the right hypoglossal canal.

Congenital axis dysmorphism in a medieval skeleton

PurposeWe describe here the axis dysmorphism that we observed in the skeletal remains of a human child dug up from a fifteenth century cemetery located in north-eastern Italy. This bone defect is discussed in the light of pertinent literature.MethodsWe performed macroscopical examination and CT scan analysis of the axis.ResultsAxis structure was remarkably asymmetric. Whilst the left half exhibited normal morphology, the right one was smaller than normal, and its lateral articular surface showed horizontal orientation. In addition, the odontoid process appeared leftward deviated and displayed a supplementary articular-like facet situated on the right side of its surface.ConclusionsThese findings suggest a diagnosis of unilateral irregular segmentation of atlas and axis, a rare dysmorphism dependent upon disturbances of notochordal development in early embryonic life. Likewise other malformations of the craniovertebral junction, this axis defect may alter the delicate mechanisms of upper neck movements and cause a complex series of clinical symptoms. This is an emblematic case whereby human skeletal remains may provide valuable information on the anatomical defects of craniovertebral junction.

The quiet necrosis

BACKGROUND osteochondritis dissecans (OCD) is an ancient disease with few well-described cases in paleopathological records. Here, we report a very rare case of OCD on both lateral femoral condyles and on the lateral condyle of the right tibia in an early medieval human skeleton. METHODS macroscopic examination of the bone vestiges of a young male unearthed from a 6th-8th Lombard cemetery in the northeast Italy was perform. RESULTS We observed a circular crater-like depression with well-defined smooth margins and exposure of the trabecular bone on both lateral femoral condyles and in the lateral condyle of the right tibia. The left tibia was fragmented and the lateral condyle was lacking. Findings are consistent with the diagnosis of multifocal juvenile osteochondritis dissecans of the knee. CONCLUSION Research in past and modern skeletal remains can contribute to define the nature and distribution of OCD.

Of flesh and blood I am made – The anatomical study of the recently unveiled wooden Christ of Donatello in Santa Maria dei Servi, in Padua

ABSTRACT The wooden Crucifix of the Santa Maria dei Servi Church in Padua was recently attributed to the great sculptor Donatello. This crucifix recently underwent a demanding restoration. In the context of a multidisciplinary study of this sculpture, several analyses were carried out (Digital Rx, 3D scanning, CT scanning and micro-stratigraphic analysis) and the anatomical study was performed. Donatello sculpted the anatomy of this Christ realistically reproducing the human body, emphasizing some particulars, with less attention to details in the regions of the body hidden by the Crux. A swelling is well appreciable just below the lateral portion of the inguinal ligament, on the right thigh. It is a six cm wide bulge and it could be the consequence of the beating suffered by Christ before the crucifixion.

Capitate-trapezoid synostosis: analysis of an Early Bronze Age case and review of the literature

BACKGROUND Carpal synostoses are congenital defects characterised by complete or incomplete coalition of two or more carpal bones. Although most of these defects are discovered only incidentally, sometimes they become clinically manifest. Among the different types of carpal coalition, the synostosis between capitate and trapezoid bones is quite rare, with only sparse data available in the literature. The aim of this report was to describe a case of capitate-trapezoid synostosis (CTS) observed in an ancient human skeleton, as well as to scrutinise the pertinent literature in order to assess for the characteristics of this type of defect, including its potential relevance to clinical practice. MATERIALS AND METHODS We studied the skeletal remains of an Early Bronze Age male warrior affected by incomplete CTS. Macroscopic and radiological examination of the defect was carried out. We also performed a comprehensive PubMed search in the Medline and other specialty literature databases to retrieve and analyse data relevant to the subject under consideration. RESULTS AND CONCLUSIONS The present case is the most ancient CTS ever found. In those literature-reported cases accompanied by careful anatomical description, such as the present one, incomplete coalition invariably occurs between the dorsal surfaces of the two bones, this characteristic emerging as a distinctive morphological trait. Literature analysis further suggests that the true prevalence of CTS is likely to be higher than estimates based on data gathered from radiology series, and that this defect may be associated with pain and carpal bossing more frequently than generally thought.

Upward displacement of the odontoid process into the foramen magnum: a palaeopathological case

An upward displacement of the odontoid process into the foramen magnum was observed in the skeletal remains of a young male unearthed from a 14th-17th century cemetery in the north-eastern Italy. Examination of skull bone vestiges and CT-SCAN analysis of the axis exhibited a clear-cut contact zone between the odontoid process and the anterior border of the foramen magnum. In addition, the odontoid process appeared backward deviated. Findings suggest a possible diagnosis of basilar impression/invagination. This anomalous contact may cause compression of neural and vascular structures with a multifaceted series of clinical symptoms. We are unable to set our finding into a complete presumptive diagnostic outline because there is no chance to estimate either the magnitude of the whole CVJ defect but we believe that the present case contributes to the general knowledge of the craniovertebral region and to bone pathology in ancient times.