title: Approach to the diagnosis of unusual carpal ankylosis from ancient Egypt.
abstract: OBJECTIVE
  Carpal fusion is not an uncommon finding in archaeological bones. The majority of cases are due to inflammatory or infectious diseases and those are usually associated with other major alterations in the skeleton.
  
  
  METHODS
  Two distinct individual cases, both adult females recovered from the Necropolis of Sharuna in the Middle Egypt from the Ptolemaic Period (IV to I BC) are presented in this study. Specimen 4323/1 shows a fusion of the scaphoid, lunate and triquetral bones in the right wrist. Specimen 4323/2 is a very rare fusion of a dysplastic lunate bone with the radius in the left wrist. In the proximal end of that left wrist, two possible remains of the flattened scaphoid and triquetral bones are also present.
  
  
  RESULTS
  A differential diagnosis of both abnormalities as well as broad research into similar paleopathological cases were carried out: the most probable diagnosis for the specimen 4323/1 is an uncommon carpal coalition of three bones from the same row; the diagnosis of the specimen 4323/2 is more dubious with both rheumatoid arthritis and septic arthritis being strong candidates.
  
  
  CONCLUSIONS
  In archaeological remains, carpal fusion should be thoroughly studied in order to ensure an accurate differential diagnosis.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Sagrat Cor, Barcelona; and Museu Egipci de Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Isidro
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Sagrat Cor, Barcelona, Spain.
authors.forename: Ivan
authors.initials: I
authors.lastname: Díez-Santacoloma
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Sagrat Cor, Barcelona; and Hand Unit, M.C. Mutual, Barcelona, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Méndez-López
mesh_terms: D000328:Adult; D000365:Age Determination by Skeleton; D000844:Ankylosis / Q000266:history* / Q000473:pathology; D001170:Arthritis, Infectious / Q000266:history* / Q000473:pathology; D001172:Arthritis, Rheumatoid / Q000266:history* / Q000473:pathology; D002348:Carpal Bones / Q000473:pathology; D003937:Diagnosis, Differential; D000076144:Egypt, Ancient; D005260:Female; D049690:History, Ancient; D006801:Humans; D008875:Middle Aged; D010164:Paleopathology / Q000379:methods*; D011237:Predictive Value of Tests; D054881:Sex Determination by Skeleton; D014955:Wrist Joint / Q000473:pathology