A rare case of congenital humeroradioulnar synostosis from medieval Pawłów Trzebnicki, Poland

Abstract

AbstractCongenital synostoses are defined as rare abnormal formations of primary anatomical structures. There are three major classifications: (a) skeletal anomalies, (b) soft tissue anomalies, and (c) anomalies involving both skeletal and soft tissues. Radioulnar synostosis is the most common form of upper limb abnormality. Synostoses between the humerus and either the ulna, radius, or both have been documented but are far less common. Of these cases, the most common type is humeroradial synostosis followed by humeroradioulnar and humeroulnar synostosis. This study presents a case of a late medieval (15th–16th c. A.D) adult male skeleton housed at the Hirszfeld Institute of Immunology and Experimental Therapy of the Polish Academy of Sciences with bilateral upper limb synostosis. Macroscopic and radiographic analyses suggest a diagnosis of congenital humeroradioulnar and humeroulnar synostosis. The right radius and ulna are hypoplastic. The left radial neck was reduced. The left radial head and the radial notch of the left ulna were absent. The radiographs demonstrate that the skeletal structures of the elbow are absent, suggesting fusion of the radius and ulna. A review of the clinical and bioarchaeological literature was conducted to assess differential diagnoses for the conjoined humerus, radius, and ulna. To the best of the authors' knowledge, this is the first case of congenital humeroradioulnar synostosis in the paleopathological literature.