Early Medical Skull Surgery for Treatment of Post-Traumatic Osteomyelitis 5,000 Years Ago
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{"title"=>"Early medical skull surgery for treatment of post-traumatic osteomyelitis 5,000 years ago", "type"=>"journal", "authors"=>[{"first_name"=>"Pierpaolo", "last_name"=>"Petrone", "scopus_author_id"=>"7003831768"}, {"first_name"=>"Massimo", "last_name"=>"Niola", "scopus_author_id"=>"6503896507"}, {"first_name"=>"Pierpaolo", "last_name"=>"Di Lorenzo", "scopus_author_id"=>"21633997300"}, {"first_name"=>"Mariano", "last_name"=>"Paternoster", "scopus_author_id"=>"49864091000"}, {"first_name"=>"Vincenzo", "last_name"=>"Graziano", "scopus_author_id"=>"49863207100"}, {"first_name"=>"Giuseppe", "last_name"=>"Quaremba", "scopus_author_id"=>"8530583400"}, {"first_name"=>"Claudio", "last_name"=>"Buccelli", "scopus_author_id"=>"6603088840"}], "year"=>2015, "source"=>"PLoS ONE", "identifiers"=>{"pmid"=>"26018014", "doi"=>"10.1371/journal.pone.0124790", "pui"=>"607973729", "issn"=>"19326203", "sgr"=>"84956680788", "scopus"=>"2-s2.0-84956680788"}, "id"=>"c2c07a5c-0272-31b2-950a-a6adde2a8ccb", "abstract"=>"Here we describe the findings of a unique example of the early techniques adopted in neurosurgery around 5000 years ago, consisting in a double well healed skull trephination associated with a post-cranial traumatic event occurring intra vitam to a young male from the Early Chalcolithic cemetery of Pontecagnano (South Italy, ca. 4,900 - 4,500 cal BP). Morphological, X-ray and 3D-CT scan skull-cap evaluation revealed that the main orifice was produced by scraping, obtained by clockwise rotary motion of a right-handed surgeon facing the patient, while the partial trephination was carried out by using a stone point as a drilling tool. In both cases, bone regrowth is indicative of the individual's prolonged postoperative survival and his near-complete recovery. The right femur shows a poorly healed mid-shaft fracture presumably induced by a high energy injury, and a resulting chronic osteomyelitis, affecting both femurs by hematogenous spread of the infection. Our observations on the visual and radiological features of skull and femur lesions, along with evidence on the timing of experimental bone regrowth vs. healing of lower limb fractures associated to long-term bone infections now suggest that this young man underwent a double skull trephination in order to alleviate his extremely painful condition induced by chronic osteomyelitis, which is thought to have been the cause of death.", "link"=>"http://www.mendeley.com/research/early-medical-skull-surgery-treatment-posttraumatic-osteomyelitis-5000-years-ago", "reader_count"=>18, "reader_count_by_academic_status"=>{"Librarian"=>1, "Researcher"=>3, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>4, "Student > Postgraduate"=>2, "Other"=>1, "Student > Master"=>3, "Student > Bachelor"=>1, "Lecturer"=>1, "Professor"=>1}, "reader_count_by_user_role"=>{"Librarian"=>1, "Researcher"=>3, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>4, "Student > Postgraduate"=>2, "Other"=>1, "Student > Master"=>3, "Student > Bachelor"=>1, "Lecturer"=>1, "Professor"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>1, "Environmental Science"=>1, "Nursing and Health Professions"=>1, "Medicine and Dentistry"=>6, "Agricultural and Biological Sciences"=>4, "Arts and Humanities"=>2, "Social Sciences"=>1, "Computer Science"=>1, "Decision Sciences"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>6}, "Social Sciences"=>{"Social Sciences"=>1}, "Decision Sciences"=>{"Decision Sciences"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>4}, "Computer Science"=>{"Computer Science"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>1}, "Unspecified"=>{"Unspecified"=>1}, "Environmental Science"=>{"Environmental Science"=>1}, "Arts and Humanities"=>{"Arts and Humanities"=>2}}, "reader_count_by_country"=>{"United States"=>1}, "group_count"=>2}

Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/2084174"], "description"=>"<p>Frontal (A) and sagittal (B) plane CT scan. Extensive and irregular bone reconstruction is apparent. No evidence is seen of incomplete healing processes as in the case of complication by infection. Note the different angle at the top/bottom (frontal plane) (A) and front/back (sagittal plane) (B) bone around the hole, indicative of right-handed clockwise rotation applied during the action of scraping (arrows). Detail of the main lesion, whose edges show active regenerative bone processes (A1). Endocranial aspect of the lesion. The bone surrounding the hole is intact (A2). 3D reconstruction of the outer aspect of the trepanned cranial vault. The arrows show the clockwise rotation movement (C). Scale bars measure 3 cm.</p>", "links"=>[], "tags"=>["femur", "bp", "bone regrowth vs", "osteomyeliti", "skull trephination", "Medical Skull Surgery", "infection", "fracture"], "article_id"=>1427488, "categories"=>["Biological Sciences"], "users"=>["Pierpaolo Petrone", "Massimo Niola", "Pierpaolo Di Lorenzo", "Mariano Paternoster", "Vincenzo Graziano", "Giuseppe Quaremba", "Claudio Buccelli"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0124790.g003", "stats"=>{"downloads"=>2, "page_views"=>20, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Three_dimensional_3D_computed_tomography_CT_scan_of_the_main_skull_trephination_/1427488", "title"=>"Three-dimensional (3D) computed tomography (CT) scan of the main skull trephination.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-05-27 02:44:56"}
  • {"files"=>["https://ndownloader.figshare.com/files/2084175"], "description"=>"<p>Coronal (A) and sagittal (B) plane CT scan cross section sequence. Note the oblique orientation of the hole walls, and the defect edges remodeled into one compact bone layer, as a result of the loss of diploic structures. The smoothed, beveled edges are also indicative of bone regrowth. Scale bars measure 3 cm.</p>", "links"=>[], "tags"=>["femur", "bp", "bone regrowth vs", "osteomyeliti", "skull trephination", "Medical Skull Surgery", "infection", "fracture"], "article_id"=>1427489, "categories"=>["Biological Sciences"], "users"=>["Pierpaolo Petrone", "Massimo Niola", "Pierpaolo Di Lorenzo", "Mariano Paternoster", "Vincenzo Graziano", "Giuseppe Quaremba", "Claudio Buccelli"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0124790.g004", "stats"=>{"downloads"=>1, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Three_dimensional_3D_computed_tomography_CT_scan_slices_of_the_main_skull_trephination_/1427489", "title"=>"Three-dimensional (3D) computed tomography (CT) scan slices of the main skull trephination.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-05-27 02:44:56"}
  • {"files"=>["https://ndownloader.figshare.com/files/2084176"], "description"=>"<p>(A, B) Sagittal plane CT scan (A). Only the external cortical layer of the bone is affected (arrow). Detail of the cone-shaped lesion, identified as an incomplete trephination with a possible ritual purpose (B). Bone remodeling, hypervascularity and pitting of the ectocranial surface suggest an advanced phase of the bone healing process. Scale bar measures 3 cm.</p>", "links"=>[], "tags"=>["femur", "bp", "bone regrowth vs", "osteomyeliti", "skull trephination", "Medical Skull Surgery", "infection", "fracture"], "article_id"=>1427490, "categories"=>["Biological Sciences"], "users"=>["Pierpaolo Petrone", "Massimo Niola", "Pierpaolo Di Lorenzo", "Mariano Paternoster", "Vincenzo Graziano", "Giuseppe Quaremba", "Claudio Buccelli"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0124790.g005", "stats"=>{"downloads"=>1, "page_views"=>24, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Three_dimensional_3D_computed_tomography_CT_scan_of_the_minor_skull_trephination_/1427490", "title"=>"Three-dimensional (3D) computed tomography (CT) scan of the minor skull trephination.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-05-27 02:44:56"}
  • {"files"=>["https://ndownloader.figshare.com/files/2084177"], "description"=>"<p>Anterior (A), medial (B), posterior (C) and lateral (D) views of the middle shaft of the right femur showing a transverse simple linear fracture (arrows), characterized by unhealed margins and lack of bone callus regeneration (A-D). Wide cloaca opening, surrounded by reactive bone (D). Detail of few bone bridges (box) on the medial aspect of the lesion, indicative of poor bone repair. Scale bar equals 1 cm.</p>", "links"=>[], "tags"=>["femur", "bp", "bone regrowth vs", "osteomyeliti", "skull trephination", "Medical Skull Surgery", "infection", "fracture"], "article_id"=>1427491, "categories"=>["Biological Sciences"], "users"=>["Pierpaolo Petrone", "Massimo Niola", "Pierpaolo Di Lorenzo", "Mariano Paternoster", "Vincenzo Graziano", "Giuseppe Quaremba", "Claudio Buccelli"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0124790.g006", "stats"=>{"downloads"=>0, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Details_of_the_femoral_nonunion_fracture_/1427491", "title"=>"Details of the femoral nonunion fracture.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-05-27 02:44:56"}
  • {"files"=>["https://ndownloader.figshare.com/files/2084186"], "description"=>"<p>Latero-lateral (A) and antero-posterior (B) X-ray images, and posterior view (C) of the right femur (A, B). Diffuse periosteal new bone apposition (<i>involucrum</i>) testified by a more radiolucent enlarged cortical bone layer, a reduced medullary cavity, and a cloaca drainage canal, diagnostic of long-term chronic osteomyelitis (C). Abnormal size of the femoral shaft induced by periosteal new bone apposition. At the mid-shaft, the fracture line and the cloaca opening are evident (arrows). Scale bar equals 5 cm.</p>", "links"=>[], "tags"=>["femur", "bp", "bone regrowth vs", "osteomyeliti", "skull trephination", "Medical Skull Surgery", "infection", "fracture"], "article_id"=>1427493, "categories"=>["Biological Sciences"], "users"=>["Pierpaolo Petrone", "Massimo Niola", "Pierpaolo Di Lorenzo", "Mariano Paternoster", "Vincenzo Graziano", "Giuseppe Quaremba", "Claudio Buccelli"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0124790.g007", "stats"=>{"downloads"=>1, "page_views"=>18, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Traumatic_and_osteomyelitic_femoral_lesions_/1427493", "title"=>"Traumatic and osteomyelitic femoral lesions.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-05-27 02:44:56"}
  • {"files"=>["https://ndownloader.figshare.com/files/2084187"], "description"=>"<p>Posterior (A), anterior (B), and medial (C) views of the transverse simple linear fracture. New bone apposition (<i>involucrum</i>) is evident. The bone lesion is characterized by poor healing (arrows) (D). Detail of the cloaca opening (box) and, above, the uninterrupted fracture line. Scale bar equals 3 cm.</p>", "links"=>[], "tags"=>["femur", "bp", "bone regrowth vs", "osteomyeliti", "skull trephination", "Medical Skull Surgery", "infection", "fracture"], "article_id"=>1427494, "categories"=>["Biological Sciences"], "users"=>["Pierpaolo Petrone", "Massimo Niola", "Pierpaolo Di Lorenzo", "Mariano Paternoster", "Vincenzo Graziano", "Giuseppe Quaremba", "Claudio Buccelli"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0124790.g008", "stats"=>{"downloads"=>0, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Three_dimensional_3D_computed_tomography_CT_scan_of_the_femoral_lesion_/1427494", "title"=>"Three-dimensional (3D) computed tomography (CT) scan of the femoral lesion.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-05-27 02:44:56"}
  • {"files"=>["https://ndownloader.figshare.com/files/2084188"], "description"=>"<p>Scr = scraping; Inc = incision; P-T = post-traumatic; L-term = long-term; S-term = short-term;? = undefined Ref (Reference): 1 = Capasso et al. (2002); 2 = Fornaciari et al. (1993); 3 = Present article</p><p>Cases of cranial trephination in the protohistory of the Italian peninsula.</p>", "links"=>[], "tags"=>["femur", "bp", "bone regrowth vs", "osteomyeliti", "skull trephination", "Medical Skull Surgery", "infection", "fracture"], "article_id"=>1427495, "categories"=>["Biological Sciences"], "users"=>["Pierpaolo Petrone", "Massimo Niola", "Pierpaolo Di Lorenzo", "Mariano Paternoster", "Vincenzo Graziano", "Giuseppe Quaremba", "Claudio Buccelli"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0124790.t001", "stats"=>{"downloads"=>5, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cases_of_cranial_trephination_in_the_protohistory_of_the_Italian_peninsula_/1427495", "title"=>"Cases of cranial trephination in the protohistory of the Italian peninsula.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-05-27 02:44:56"}
  • {"files"=>["https://ndownloader.figshare.com/files/2084189"], "description"=>"<p>Differential diagnosis for skull trephination (modified from Steinbock, 1976, Aufderheide et al., 1997, and Ortner, 2003).</p>", "links"=>[], "tags"=>["femur", "bp", "bone regrowth vs", "osteomyeliti", "skull trephination", "Medical Skull Surgery", "infection", "fracture"], "article_id"=>1427496, "categories"=>["Biological Sciences"], "users"=>["Pierpaolo Petrone", "Massimo Niola", "Pierpaolo Di Lorenzo", "Mariano Paternoster", "Vincenzo Graziano", "Giuseppe Quaremba", "Claudio Buccelli"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0124790.t002", "stats"=>{"downloads"=>6, "page_views"=>28, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Differential_diagnosis_for_skull_trephination_modified_from_Steinbock_1976_Aufderheide_et_al_1997_and_Ortner_2003_/1427496", "title"=>"Differential diagnosis for skull trephination (modified from Steinbock, 1976, Aufderheide et al., 1997, and Ortner, 2003).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-05-27 02:44:56"}
  • {"files"=>["https://ndownloader.figshare.com/files/2084190"], "description"=>"<p>Taphonomic (biological, geological, human) agents possibly involved in causing the skull lesions.</p>", "links"=>[], "tags"=>["femur", "bp", "bone regrowth vs", "osteomyeliti", "skull trephination", "Medical Skull Surgery", "infection", "fracture"], "article_id"=>1427497, "categories"=>["Biological Sciences"], "users"=>["Pierpaolo Petrone", "Massimo Niola", "Pierpaolo Di Lorenzo", "Mariano Paternoster", "Vincenzo Graziano", "Giuseppe Quaremba", "Claudio Buccelli"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0124790.t003", "stats"=>{"downloads"=>1, "page_views"=>14, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Taphonomic_biological_geological_human_agents_possibly_involved_in_causing_the_skull_lesions_/1427497", "title"=>"Taphonomic (biological, geological, human) agents possibly involved in causing the skull lesions.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-05-27 02:44:56"}
  • {"files"=>["https://ndownloader.figshare.com/files/2084167"], "description"=>"<p>Grave 6589 consists of a single funerary chamber and a pit. The last deposition (specimen 6589.1, dark gray) is positioned at the center of the chamber, while three more skeletons are shifted (secondary burial) to the north-west side. A further group of bones belong to a dog’s skeleton. Scale bar measures 1 meter (modified from Bailo Modesti et al. 1998).</p>", "links"=>[], "tags"=>["femur", "bp", "bone regrowth vs", "osteomyeliti", "skull trephination", "Medical Skull Surgery", "infection", "fracture"], "article_id"=>1427481, "categories"=>["Biological Sciences"], "users"=>["Pierpaolo Petrone", "Massimo Niola", "Pierpaolo Di Lorenzo", "Mariano Paternoster", "Vincenzo Graziano", "Giuseppe Quaremba", "Claudio Buccelli"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0124790.g001", "stats"=>{"downloads"=>0, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Plan_of_grave_PC_6589_/1427481", "title"=>"Plan of grave PC 6589.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-05-27 02:44:56"}
  • {"files"=>["https://ndownloader.figshare.com/files/2084173"], "description"=>"<p>Superior (A) and lateral (B) view and corresponding X-ray images of the skull-cap. Wide crater-like elliptical depression across the bregma, showing well-defined, irregular borders (A, B). Gross morphology and X-ray images show healing, new bone being more radiolucent and with less mature architecture compared with surrounding old bone. A further minor depression in located close to the lambda (arrows) (A, B). Scale bar equals 5 cm.</p>", "links"=>[], "tags"=>["femur", "bp", "bone regrowth vs", "osteomyeliti", "skull trephination", "Medical Skull Surgery", "infection", "fracture"], "article_id"=>1427487, "categories"=>["Biological Sciences"], "users"=>["Pierpaolo Petrone", "Massimo Niola", "Pierpaolo Di Lorenzo", "Mariano Paternoster", "Vincenzo Graziano", "Giuseppe Quaremba", "Claudio Buccelli"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0124790.g002", "stats"=>{"downloads"=>1, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Double_skull_trephination_affecting_specimen_6589_1_/1427487", "title"=>"Double skull trephination affecting specimen 6589.1.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-05-27 02:44:56"}

PMC Usage Stats | Further Information

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Relative Metric

{"start_date"=>"2015-01-01T00:00:00Z", "end_date"=>"2015-12-31T00:00:00Z", "subject_areas"=>[]}
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