No. 148, December 2009 Paleopathology Newsletter 25 Developmental Dysplasia of the Hip in a Post-Medieval Transylvanian Population: Case study and Diagnosis Jacqueline T. Eng 1 , Péter Szőcs 2 , Connor Hagen 1 1 Department of Anthropology, Western Michigan University, Kalamazoo, MI 49008 2 Satu Mare County Museum, Romania, 440031 Satu Mare, str. V. Lucaciu no. 21 Introduction Developmental dysplasia of the hip (DDH) is an abnormal formation of the hip resulting from displacement of the femoral head from an abnormally formed acetabulum. Despite being one of the most common congenital defects affecting neonates, there has been confusion over the forms of the condition, including ambiguity of terminology and diagnostic criteria (Kokavc and Bialik 2007). This structural deformity has also been called congenital dislocation of the hip (CDH), but was changed to developmental dysplasia or dislocation of the hip in 1988, which has gained wider acceptance by most pediatric orthopedic associations (Klisic 1989). Note, however, that dysplasia itself is defined by Stedman’s medical dictionary as “abnormal tissue development,” leading to redundancy of terminology. The term DDH is a more fully comprehensive term, however, that emphasizes both the congenital and progressive aspects of the condition, which may initially be manifest as a predisposition for subluxation of the femoral head before a complete dislocation (luxation) later in development (Dwek et al. 2002; Hartofilakidis et al. 2008). Today, doctors routinely screen newborns for early manifestation for DDH, detectable in a physical exam as a hip that is “dislocated, dislocatable, luxated, luxtable,…[and] unstable,” with an estimated rate of 8.6 per 1000 births, but with higher detection during orthopedic screening (11.5), and highest with ultrasonography (25) (Lehmann et al. 2000:896-897). In the pre-modern era, DDH would have likely gone undetected until it was too late to treat (Roberts and Manchester 2005), and in the absence of spontaneous reduction, DDH results in distinctive skeletal changes that may have severely impacted the lifestyle of an afflicted individual. Since spontaneous reductions of hip dislocations when the anatomy of the acetabulum is abnormal are unlikely, the presence of DDH in archaeological samples should more accurately represent actual frequency than other joint dislocations, such as that of the shoulder (Ortner 2003:161). This paper briefly reviews the criteria for diagnosis of DDH in skeletal remains and looks at a post-Medieval population from Transylvania, Romania, to document the evidence of DDH within this skeletal collection. Transylvania: Bobald Cemetery Sample In 2001 and 2002, the Satu Mare County Museum excavated the cemetery of the former Hungarian village of Bobald, situated in the northwestern edge of Transylvania, Romania (Figure 1). After one third of the site had been destroyed by a sand-mine, salvage excavations uncovered approximately 147 burials through test trenches. While the graves contained single burials in wooden coffins, there were several instances of intrusive burials that led to commingling of the skeletal material. Osteological inventory of the remains yielded a minimum number of 162 individuals.