Bilateral Femoral and Tibial Periostitis in the La Ferrassie 1 Neanderthal

Abstract

Preserved in the older adult male La Ferrassie 1 skeleton are the skull, all of the major long-bone diaphyses and most epiphyses, the scapulae and pelvis, most of the hand and foot remains with minor damage, and fragmentary elements of the majority of the axial skeleton. In addition to periodontal lesions, minor vertebral osteoarthritis, and a fractured greater trochanter, La Ferrassie 1 exhibits marked bilateral, largely symmetrical periostitis of the distal femoral diaphyses and especially of the distal tibial diaphyses, with less pronounced involvement of the proximal tibial and distal fibular diaphyses. The preserved periosteal new bone is not invasive of the underlying cortical bone, nor is it present inside the articular capsule attachment areas or on the subchondral bone. There is minimal involvement of the upper limb long bones, but not of the hand or foot remains. The periostitis therefore appears as a bilateral, highly active, localized set of lesions at the time of death. Differential diagnosis suggests that these lesions are the result of a systemic involvement, most likely hypertrophic pulmonary osteoarthropathy (HPO) (also called secondary hypertrophic osteoarthropathy). The primary cause of HPO is usually thoracic infection and/or carcinomas, most often pulmonary. Secondary lesions commonly associated with this, but not present on La Ferrassie 1 to the extent of skeletal involvement, are clubbed fingers and toes with metacarpal, metatarsal and phalangeal periostitis in advanced cases. Consequently, La Ferrassie 1 appears to have had a sufficiently acute case of HPO to produce pronounced femoral and tibial periarticular periostitis but not sufficiently advanced for hand and/or foot involvement. This is the only known case of systemic effects of an infection/carcinoma among the Neanderthals.