Not written on the records: a rare case of ipsilateral disappearance of the femoral head and neck and other bone abnormalities on a female skeleton from the Luís Lopes Collection (Lisbon, Portugal)

Abstract

This article aims to describe a paleopathological case consistent with a paediatric hip joint trauma, discussing its aetiologies and lifelong implications, such as limb asymmetry and osteoarthritis. The case studied is a well-preserved skeleton of a female individual (Museu Nacional de História Natural e da Ciência, Universidade de Lisboa) who died in Lisbon in 1954, at the age of 54. The bone changes were macroscopic and radiologically studied, complemented by a differential diagnosis. The study revealed ante mortem absence of the left femur head and neck, marked shortening and narrowing of the left os coxae, and alterations in the acetabulum. Additionally, an atrophy of the left lower limb was observed, except for the metatarsals and toes, torsion of the right femoral neck, and severe right knee osteoarthritis. A traumatic fracture affecting the acetabulum and the proximal femur during the developmental stage of the individual’s life may account for the spectrum of changes observed in the post-cranial skeleton, albeit other conditions, such as septic arthritis of the hip, were also considered in the differential diagnosis. These fractures likely disrupted the blood supply, leading to necrosis and subsequent resorption of the femoral head, associated with adjustments in the shape of the acetabulum and atrophy of the lower limb. Trauma in a still immature skeleton can significantly impact the affected individual’s life, as it may lead to pernicious secondary complications.