Geriatric chronic recurrent multifocal osteomyelitis (CRMO) mimicking multifocal multiple myeloma: a first in an octogenarian.

Chronic recurrent multifocal osteomyelitis (CRMO), an autoinflammatory bone disorder characterized by non-bacterial osteomyelitis causing recurrent multifocal bone lesions, is a well-known, yet uncommon pediatric condition that rarely affects adults; to date, it has never been diagnosed over the age of 75. The following report will discuss the first octogenarian diagnosed with CRMO and therefore represents an exceptionally rare presentation of a rare disease. An 83-year-old woman presented with progressive right shoulder, forearm, and hip pain, with associated weight loss and global weakness, requiring a wheelchair for mobility. Imaging revealed a pathologic right ulna fracture in addition to lytic lesions of the right proximal humerus and proximal femur. The clinical picture was thus that of a patient with probable multiple myeloma versus metastatic disease. After an extensive workup, however, the lesions were not malignant; histologic findings were instead suggestive of chronic osteomyelitis with negative cultures. Given the multifocal nature of this condition, combined with a lack of clinical symptoms of infection, a diagnosis of CRMO was rendered. The patient underwent intramedullary nailing of the right femur and splinting of the ulna, with a subsequent remarkable recovery to painless ambulation, complete union of the right ulna fracture, and resolution of the lytic lesions without receiving any targeted medical treatment. This case highlights the importance of maintaining CRMO on the differential for multifocal skeletal lesions, regardless of age. Performing a thorough workup with necessary imaging, biopsy, and culture are critical to establishing this diagnosis, which can only made as a diagnosis of exclusion.

Radiographic comparison of a fractured clavicle exhibiting a pseudo-arthrosis.

Bone remodeling is a natural process that is potentially problematic for radiographic comparisons because it can occur after antemortem (AM) imaging, thus interfering with the comparability of AM and postmortem (PM) radiographs from the same individual. While the effects of age-related remodeling have been studied, limited attention has been given to trauma-related remodeling with respect to radiographic comparisons. This report adds to the latter topic by presenting a case of AM clavicle fracture that developed into a pseudo-arthrosis over a 12-month period prior to the individual's death. Even though remodeling was discernable along the fracture margins, adjacent skeletal features on the PM radiograph remained unaltered and constituted compelling evidence for the identification. This case illustrates the potential of using both normal and pathological anatomy concurrently to maximize the surety of findings from radiographic comparisons.

Influence of cranial deformation on facial morphology among prehistoric South Central Andean populations.

Calculating biodistances among South American populations using cranial measurements is often hindered, as many available skeletal collections exhibit deformation. Acknowledging vault modifications, researchers have sought measurements in other regions which are unaffected by deformation. In the 1970s, a set of 10 "relatively" unaffected facial measurements was identified in Argentinean crania that later became the basis of numerous South American biodistance studies. These measurements include: minimum frontal breadth, bizygomatic breadth, orbit height, orbit breadth, palate breath, palate length, upper facial height, basion-prosthion length, nasal height, and nasal breadth. Palate length was excluded from the present analysis due to considerable measurement error. The suitability of these measurements in populations other than Argentineans has not been rigorously tested. Using a sample of 350 prehistoric crania from the Museo Arqueológico San Miguel de Azapa (MASMA, Arica, Chile), this project tested the hypothesis that these measurements are unaffected by either annular or tabular deformation. Results obtained from MANOVA analysis indicate this hypothesis cannot be fully supported. Among males, only 3 of the 9 measurements are unaffected by either form of deformation (palate breadth, basion-prosthion length, and nasal breadth), while analysis of females indicates that 4 of the 9 measurements remain unaltered (minimum frontal breadth, orbit breadth, basion-prosthion length, and nasal breadth). Additionally, analogous to the vault, facial measurements display patterns consistent with the deformation applied. Two implications can be drawn from this research: 1) previous studies using these measurements must be interpreted cautiously, and 2) researchers using these measurements must explicitly test their suitability in each population.