Skeletal pathology in a prehistoric Pacific Island sample: issues in lesion recording, quantification, and interpretation.

This paper presents a profile of evidence of disease in a skeletal sample from Taumako Island, Southeast Solomon Islands, Melanesia, and aims to increase awareness of the prehistoric Pacific Island disease environment. It also addresses issues of lesion recording, quantification, and interpretation. Two methodologies for the determination of lesion prevalence were applied, one based on prevalence in observable individuals and one in skeletal elements. The aim of these methodologies was to provide objective data on skeletal lesions in this sample, with transparency in methods for application in comparative studies. The types of lesions observed were predominantly osteoblastic and affecting multiple bones, particularly in the lower limbs. The individual analysis yielded a prevalence of lesions affecting 56.4% of the postcranial sample from birth to old age. As expected, the skeletal element analysis yielded a lower prevalence, with 15.0% of skeletal elements affected. The skeletal element analysis also revealed a pattern of greater lower limb involvement, with a predilection for the tibia. The pattern of skeletal involvement was similar in both analyses, suggesting the validity of employing either method in paleopathological studies. A differential diagnosis of the lesions included osteomyelitis, treponemal disease, and leprosy. Metabolic disease was also considered for subadult lesions. Based on lesion type, skeletal distribution, and epidemiology of lesions in the sample, an etiology of yaws (Treponema pertenue) was suggested as responsible for nearly half the adult lesions, while multiple causes, including yaws, were suggested for the lesions in subadults.

El pie en lepra

Con el siguiente artículo los autores pretenden describir las diferentes manifestaciones clínicas que pueden aparecer en la extremidad inferior, con especial atención al pie, en pacientes de lepra en todas sus formas clínicas, tanto activos como de alta terapéutica con secuelas secundarias a la enfermedad. Se describen las manifestaciones dermatológicas, neurológicas, las alteraciones tróficas, óseas y radiológicas presentes en pacientes controlados en el Sanatorio de Fontilles. Se expone la forma actual de trabajo en el campo, con la clasificación de los pacientes en Paucibacilares y Multibacilares, el tratamiento específico de la enfermedad y los cuidados locales a realizar (AU)

[Apropos of a case of perforating, leprous plantar ulcer occuring at 15 years of age]. / A propos d'un cas de mal perforant plantaire lépreux survenu à l'âge de 15 ans.

Perforating ulcers of the foot occurring in leprosy are frequent, chronic, often giving mutilations. They usually affect the adult. Plantar ulcer occurred in a 15 year-old young patient affected by tuberculoid leprosy has incited us to report it.

[Course of bone lesions of leprosic feet towards dislocation of the tarsus and metatarsus]. / Evolution des lésions osseuses du pied lépreux vers la dislocation du tarse et du métatarse.

The authors have observed 135 dislocations of the tarsus in leprosic feet. They recall the mechanism of the lesion and propose a classification. 42 cases were operated on to prevent further deformities. When early treated limited arthrodeses may be beneficial in some cases. In more severe cases rebuilding arthrodesis alone or associated to cancellous bone grafting is indicated. In very severe cases amputation is only indicated because the Wladimiroff-Mickulicz technique as well as grafts lead to failures related to the metatarsophalangeal joints stiffness.

Management of tarsal disintegration (T.D.) in leprosy.

Tarsal Disintegration (T.D.) is a known entity occurring exclusively in neuropathic foot of Leprosy and being influenced by several factors among which the disease itself and altered biomechanics constitute the main. In this study done on more than fifty cases at the Dr. Bandorawalla Leprosy Hospital, Kondhawa these factors have been studied in detail and it has been found that the increased and abnormal shearing forces constitute one of the major factors both in occurrence and progression of T.D. Treatment based mainly on the conservative lines is thus aimed at minimizing these forces which occur during the heel-toe pattern gait. Depending upon the severity of the case immobilization, periodic check x-rays, graded weight bearing and suitable modified footwear appliance is recommended. A Fixed Ankle Brace (FAB) serves well controlling the ankle movements by its rocker action and ultimately reducing the forces occurring during the normal heel-toe pattern. It has also been found that if the case is detected early and treated promptly the process can be controlled satisfactorily. Careful screening in high risk group is stressed and health education emphasized.

Osteoarticular complications in anaesthetic foot.

A clinico radiological comparative study of complications in the anaesthetic foot in 60 patients (48 leprosy and 12 spinal injuries) were done. It has been observed that these groups behave differently.

[Osteoarticular lesions in leprosy (experience 1960-1982)]. / Lésions ostéo-articulaires dans la lèpre (expérience 1960-1982).

Bone changes are frequent in leprosy involving small distal bones of the limbs and, in advanced cases, some cranial bones. The various kinds of osteitis and their radiologic features are described as well as the arthritis to which they can give way. These changes may result directly from the infection by M. leprae indirectly through nerve damage and also by pyogenic infections. The therapeutic tactic is discussed according to this approach of the various types of bones and joint damage.

An unusual location of leproma of bone; a case report.

A hyperactive leproma, stimulating osteoclastoma, was excised from the distal metaphysis of the left ulna in an 18-year-old girl with borderline-lepromatous leprosy of short duration.

Tarsal disintegration (T.D.) in leprosy.

Tarsal Disintegration in leprosy has been a challenge as far as its prevention is concerned. It is, no doubt, a complex and less understood phenomenon influenced by many factors. In this study made at Dr. Bandorawalla Leprosy Hospital, Kondhawa, factors like insensitivity, loss of protective reflex, infection, lepromatous infiltration of bones etc. have been taken into consideration, but, more emphasis is laid on the biomechanical factors (i.e. altered muscle pulls due to muscular paralysis resulting in imbalance) and the resulting change in weight bearing areas and weight transmission lines. Sixteen cases of neuropathic feet were examined clinically and radiologically. All were burnt out cases of tuberculoid and borderline tuberculoid variety excepting one which was active being of lepromatous variety. Tracings made from actual radiographs of the patients were studied. It was found that apart from insensitivity, biomechanical factors play a lot of importance in accentuating the process of T.D. The changes are predominantly seen in Tuberculoid variety of Leprosy. Attempts have been made to understand this process more closely by drawing conclusions based on the kinetic and kinematic analysis of the normal human foot and comparing it with neuropathic feet.

Tarsal bone disintegration in leprosy.

Tarsal bone disintegration is characterised by fragmentation and progressive collapse of one or more tarsal bones. It occurs in 10% of leprosy patients, and is responsible for many severe foot deformities associated with this disease. The main cause is micro-traumata, but sensory impairment, sepsis and osteoporosis are predisposing factors. In this series of 400 consecutive patients the talus and navicular were involved most frequently (2% of 119 tarsal lesions). Treatment, including prolonged immobilisation of the foot, results in dense sclerosis of the affected bone, and leaves a functional limb. Initial radiological features include: (i) Bone fragmentation. (ii) Calcified fragments in adjacent soft tissues. (iii) Linear fractures. (iv) Progressive compression and deformity of the affected bone. (v) Loss of density of the affected bone. (vi) Flattening of the longitudinal plantar arch. Illustrative case histories are presented, and the differential diagnosis discussed.

Radionuclide bone-scan abnormalities in leprosy: case reports.

Radionuclide bone scans were performed on two patients with leprosy. The resulting scan patterns simulated hypertrophic osteoarthropathy and diffuse arthritis, findings entirely consistent with the primary disease process.

Bone changes in leprosy: a correlation of clinical and radiographic features

Characteristic bone lesions in leprosy affect the small bones of the face, hands, and feet. They are due directly to leprous infection imposed upon denervated tissues. The manifestations of leprous bone infection vary from the presence of bacilli in the bone to actual destruction. Distal absorption involves fingers and toes with the loss of digits. Combined absorption of lenght and width of bone often affects the metatarsophalangeal joints. Tarsal absorption patterns are determined by abnormal weight-bearing forces and infection.