Bilateral congenital radioulnar synostosis in an Early Horizon subadult burial from the site of Atalla, Peru

International Journal of Paleopathology 28 (2020) 1–5 Contents lists available at ScienceDirect International Journal of Paleopathology journal homepage: www.elsevier.com/locate/ijpp Bilateral congenital radioulnar synostosis in an Early Horizon subadult burial from the site of Atalla, Peru Sinostosis radiocubital bilateral congénita en un entierro sub-adulto del Horizonte Temprano en el sitio de Atalla, Perú T Daniela Wolina,*, Michelle Younga,1, Natali Lopez Aldaveb a b Department of Anthropology, Yale University, New Haven, CT, 06511, USA School of Social Sciences, National University of San Marcos, Lima, 15081, Peru A R TICL E INFO A BSTR A CT Keywords: Bioarchaeology Formative period Andes Congenital anomaly Objective: This study was undertaken to identify pathological conditions within the population living at Atalla (1000-500 BCE), an important early village site and ritual center located in Huancavelica, Peru. Materials: Articulated burials (N = 3) and commingled human remains excavated during the 2015 and 2016 field seasons. Methods: Osteological remains were analyzed for macroscopic evidence of pathological changes. Results: A case of bilateral proximal radioulnar fusion was observed in an Early Horizon (ca. 800 BCE) subadult skeleton (Individual 1). A differential diagnosis of this pathology supports congenital radioulnar synostosis (CRUS), a rare developmental condition. Enamel hypoplasia was also identified in the same individual. Conclusions: Burial treatment of Individual 1 does not provide any indication that CRUS was afforded an exceptional social significance. Contribution to Paleopathology: This example of CRUS is notable as it represents the second published archaeological case of CRUS from Peru and the earliest reported case globally. Limitations of this Study: The osteological sample currently available from this site is limited. Suggestions for Future Research: Increased fieldwork in this region is recommended to further clarify the distribution and social significance of CRUS in the prehistoric Andes. Palabras claves: Bioarqueología Periodo Formativo los Andes anomalía congénita R ESU MEN Objetivo: Este estudio se llevó a cabo para identificar condiciones patológicas dentro de la población antigua de Atalla (1000-500 a.C.), un sitio importante de una aldea temprana y centro ritual ubicado en Huancavelica, Perú. Materiales: Restos humanos articulados (N = 3) y mezclados excavados durante las temporadas de campo 2015 y 2016. Métodos: Se analizaron los restos osteológicos en búsqueda de evidencia macroscópica de cambios patológicos. Resultados: Se observó un caso de fusión radiocubital proximal bilateral en un esqueleto sub-adulto del Horizonte Temprano (ca. 800 a.C.). Un diagnóstico diferencial de esta patología respalda la sinostosis radiocubital congénita (CRUS), una condición de desarrollo rara. La hipoplasia del esmalte también se identificó en el mismo individuo. Conclusiones: El tratamiento del entierro del Individuo 1 no proporciona indicación alguna de que CRUS haya tenido un relevancia social excepcional. Importancia: Este ejemplo de CRUS es notable ya que representa el segundo caso arqueológico publicado de esta anomalía congénita registrada en todo el Perú y por ser el caso más temprano reportado a nivel mundial. Limitaciones de este estudio: La muestra osteológica actualmente disponible en este sitio es limitada. Sugerencias para futuras investigaciones: Se recomienda investigaciones adicionales en esta región para aclarar aún más la distribución y la importancia social de CRUS en los Andes prehistóricos. Corresponding author. Present address: Institute for the Study of the Ancient World, New York University, New York, NY, 10028, USA. E-mail addresses: daniela.wolin@nyu.edu (D. Wolin), michelle.e.young@yale.edu (M. Young), natialdave@gmail.com (N. Lopez Aldave). 1 Present address: Dumbarton Oaks Research Library and Collection, Washington, DC, 20007, USA. ⁎ https://doi.org/10.1016/j.ijpp.2019.11.004 Received 19 February 2019; Received in revised form 18 November 2019; Accepted 18 November 2019 1879-9817/ © 2019 Elsevier Inc. All rights reserved. International Journal of Paleopathology 28 (2020) 1–5 D. Wolin, et al. populations (e.g. Chapdelaine and Gagné, 2015; Nagaoka et al., 2017; Pechenkina et al., 2007; Pezo-Lanfranco, 2011; Pezo-Lanfranco et al., 2009; Tomasto Cagigao, 2009; Tomasto Cagigao et al., 2015; Tykot et al., 2006). Heavily fragmented and commingled human remains dominated the Atalla collection; however, three skeletons were uncovered from formal burial contexts. Individual 1, the subject of this study, was buried in an oval-shaped pit in one of the residential sectors (Fig. 1). The body – which was tightly flexed, head oriented to the southwest, and face positioned prone – was accompanied by a small, unworked cobble, fragmented charcoal, and an unworked piece of crystalline quartz. A roughly circular arrangement of small to mediumsized angular stones and rounded cobbles, located 30 cm to the southeast, was also associated with the burial. The skeletal remains were relatively well-preserved, but incomplete due to post-depositional damage (Fig. 2). Age estimation was based on postcranial fusion (Scheuer and Black, 2004) and dental eruption and development (Smith, 1991; Ubelaker, 1989). The individual’s young age precluded sex estimation. All elements and teeth were analyzed for evidence of pathological changes, which were recorded and photographed when observed. In order to obtain an absolute date for Individual 1, a sample from an unsided rib shaft fragment was exported from Peru under the Resolucion Directoral Nº 151-2017-VMPCIC-MC. Radiocarbon AMS analysis provided a date range of 2675 +/- 28 years BP; using OxCal 4.2/ShCal13 atmospheric, these dates are calibrated to 894−771 cal. BCE (2σ) and 825−793 cal. BCE (1σ) (Sample number: AA110581, Laboratory number: X32348). 1. Introduction The site of Atalla, located in the Huancavelica region of the southcentral Peruvian highlands, occupies a natural promontory that has been modified through stone terracing and the construction of over one hundred architectural features from prehistoric into modern times (Young, 2017). Originally settled during the late Initial period (ca. 1000 BCE), by 850 BCE Atalla was the paramount settlement in the region, unprecedented both in terms of its size and ritual importance (Burger and Matos, 2002; Matos, 1959; Ruiz Estrada, 1977; Young, 2017). Systematic archaeological investigations in this region have been limited; therefore, new finds from the site of Atalla have contributed to the small number of late Initial period (1200-800 BCE) and Early Horizon (800-400 BCE) burials previously identified (i.e. Espinoza, 2006). This study presents a differential diagnosis for bilateral proximal radioulnar fusion observed in a subadult from Atalla. The purpose of this brief communication is to acknowledge the potential significance of this second case of congenital radioulnar synostosis (CRUS) from Peru and to bring attention to the early date of this example. 2. Materials and methods Osteological analyses were carried out as part of the Proyecto de Investigación Arqueológica Atalla (2014–2017), led by one of the authors (M.Y.), with the goal of situating the occupants of Atalla within the growing bioarchaeological literature on interpersonal violence, activity, health, and diet among late Initial period and Early Horizon Fig. 1. A) Huancavelica Region, Peru; B) Location of Burial Context for Individual 1, Atalla Site. (Map credit: Luis Flores de la Oliva). 2 International Journal of Paleopathology 28 (2020) 1–5 D. Wolin, et al. Fig. 2. Skeletal Inventory for Individual 1. (Diagonal fill indicates un-sided/fragmented elements). 3. Results 4. Differential diagnosis Individual 1 was estimated to be 5–7 years old at the time of death. Two pathological conditions, unique within the Atalla assemblage, were noted during analysis. Bilateral fusion of the proximal radii and ulnae was observed as a smooth bridge of bone joining the elements near the radial notch. Marked bowing of both radii is evident (Figs. 3 and 4). Among the commingled remains examined as part of this study, two ulnae and one radius were preserved well enough to assess the presence or absence of fusion. Fusion was not identified in any of these elements or among the other two articulated individuals. Additionally, enamel hypoplasia was noted on the unerupted maxillary and mandibular permanent canines and incisors of Individual 1. The other two articulated individuals lacked dentition; however, among the commingled remains, N = 11 anterior teeth (incisors and canines) were well-preserved enough to assess oral pathological conditions. None of these decontextualized teeth displayed enamel hypoplasia. Enamel hypoplasia has been identified in roughly coeval Early Horizon populations on the Peruvian south coast (Dietz, 2009; Pezo-Lanfranco et al., 2015) and in Initial period populations on the north coast (PezoLanfranco and Eggers, 2013), suggesting that physiological stress may have been prevalent during this period of Andean prehistory. The small, dispersed sample currently available from Atalla impedes further evaluation of the potential social or environmental causes of enamel hypoplasia in Individual 1′s dentition. Based on the characteristics of the fusion, the observed pathological condition appears to be a case of radioulnar synostosis (Antón and Polidoro, 2000), which can occur across an individual’s lifetime secondary to a traumatic event or post-operative complications (Bauer et al., 1991; Ortner, 2003) or in utero (Wilkie, 1914). Post-traumatic RUS results from the ossification of a hematoma or the interosseous membrane following a fracture, dislocation, or other traumatic event (Sachar et al., 1994:402). Typically unilateral, this complication can severely limit movement and cause pain. Osteologically, post-traumatic RUS is identified by evidence of a fracture, bone remodeling and healing, and secondary changes such as osteoarthritis – none of which were observed in Individual 1. Congenital radioulnar synostosis (CRUS) occurs when the shared perichondrium of the radius and ulna fail to properly segment and subsequent endochondral ossification fuses the two elements in the position of the arms in utero – ranging from neutral to pronated (Taneja and Ramachandran, 2015). According to clinical literature, patients with CRUS often display hypermobility at the wrist and shoulder (Cleary and Omer, 1985; Ogino and Hikino, 1987); therefore, the condition is only treated surgically when movement is severely restricted or when pain renders treatment necessary (Shinohara et al., 2010; Taneja and Ramachandran, 2015). Approximately 40–80 % of all congenital cases occur bilaterally, and a slightly elevated prevalence of CRUS among males has been Fig. 3. Ulnae and Radii of Individual 1. (Left-Right: Medial and lateral views). 3 International Journal of Paleopathology 28 (2020) 1–5 D. Wolin, et al. Fig. 4. Radioulnar Fusion in Individual 1. observed (Simmons et al., 1983; Taneja and Ramachandran, 2015). The etiology of CRUS remains contentious. A familial predisposition (Davenport et al., 1924; Hansen and Andersen, 1970; Wilkie, 1914) and autosomal dominant inheritance (Rizzo et al., 1997) have been linked with this condition. CRUS is also associated with a variety of developmental disorders and syndromes (Ortner, 2003). Bilateral expression and a lack of remodeling support the hypothesis that the pathological changes observed in Individual 1 are indicative of CRUS; however, the bone changes cannot be associated with any other conditions at this time. Although radiographs would have increased our confidence in this diagnosis, the required equipment was not available at the time of analysis. Due to postmortem damage to the right proximal forearm, we could only classify the left elements as Wilkie’s (1914) Type II and Cleary and Omer’s (1985) Type III – a common clinical manifestation (Taneja and Ramachandran, 2015). Declaration of Competing Interest None Acknowledgments The 2016 excavations and osteological research were funded by a Fulbright IIE Research Award, a Rust Family Foundation Research Grant, a Yale Institute for Biospheric Studies Dissertation Improvement Grant, and the Josef Albers Traveling Foundation Fellowship at Yale University. Funding for radiocarbon AMS dating was provided by the National Science Foundation Doctoral Dissertation Research Improvement Award [#1744218]. We would like to thank Miren Bilbao, Sadie Weber, and José Luis Fuentes Sadowski, and the rest of the PIA Atalla team for their contributions to the field and lab work. Thank you also to Richard Burger, Lucy Salazar, and Anne Underhill for their guidance and to the community of Villa Hermosa-Atalla and the DDC Huancavelica for their collaboration and support for the project. We are grateful for Lauren Ledin and Gary P. Aronsen’s feedback on an earlier version of this article and for the invaluable comments and suggestions provided by the editor and two anonymous reviewers. 5. Discussion and conclusion To our knowledge, fifteen archaeological cases of CRUS have been published to date. In addition to the thirteen cases compiled by Titelbaum and Verano (2015), we identified two other accounts of CRUS (Lorrio et al., 2010; McCarthy, 2016). Individual 1 from Atalla represents the earliest example among these cases, contributing considerable time depth to the paleopathological literature. Titelbaum and Verano (2015) published the only other reported case from Peru, a 16–18 years-old female with unilateral CRUS from the Lambayeque occupation of the Huaca Cao Viejo site (ca. 950–1250 CE). The authors conclude that given their large sample the case was likely a sporadic mutation (ibid, 974) – an assessment that cannot be made for Atalla with the current sample size of articulated burials. However, the presence of a second case from Peru warrants further research into the possible etiologies of CRUS in the Central Andes. The few intact adult skeletons excavated at Atalla were also buried with meager grave goods such as ground stone tools or cobbles, suggesting that Individual 1′s mortuary treatment is congruent with the local burial pattern. 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Boletín de Arqueología Pontificia Universidad Católica del Perú 22, 9–34. 5