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The human pelvis has been reported to change in shape throughout adult lifetime, and also the expression of parturition scars, or "pelvic features", increases with age. However, little is known about the causes and timing of these changes. Here we investigate changes in pelvic shape and the expression of pelvic features by applying a comprehensive geometric morphometric approach to a modern sample of 167 adult individuals with known age, parity, and cause of death. Our results confirm that the pelvis changes in shape during adult life, but to a larger magnitude in females compared to males. Moreover, females showed three different phases of pelvic shape change, coinciding with the main period of reproduction (from 17 to about 37-40 years), the period after that but before menopause, and the postmenopausal period (after 50 years of age). Males exhibited two phases with relatively similar shape changes. The expression of parturition scars increased in females until about 40 years of age and stayed relatively constant thereafter. Only a very weak increase of feature expression was found in males. We hypothesize that changes of adult pelvic shape and feature expression result from a combination of hormone-mediated and mechanically induced bone remodeling. Estrogen-induced and pregnancy-related bone remodeling dominates in premenopausal women, whereas bone remodeling in response to mechanical factors may underlie pelvic shape changes in men and postmenopausal women. The continual widening of the birth canal during the reproductive period eases childbirth in a population, but it is unlikely that this remodeling pattern specifically evolved as an obstetric adaptation in the human lineage. The highly conserved endocrine system and estrogen-induced pelvic bone remodeling were already in place when the neonatal brain increased in the human lineage. But the regularity control of this conserved pathway may have been "fine-tuned" by selective forces in the human lineage.

The aims of this study are first, to test the relevance of the three non-metric traits in the preauricular region established by Bruzek (2002) for identifying the female population, and second, to test the relationship between the morphology of the preauricular area and parity. Age and pelvic dimensions are also analysed as potential contributing factors. The group under study, derived from the SIMON identified skeletal collection (Vaud, Switzerland), comprises individuals living at the end of the 19^th and in the first half of the 20^th centuries. The sample consists of 504 coxal bones (including 236 pairs) from 268 individuals (133 females and 135 males), aged 16 to 81, with age classes equally represented. The obstetric history is known for a subgroup of 99 females. Using the three visual criteria employed together, the results of sex estimation indicate that both the indeterminate rate (11.3% for observer 1 and 7.7% for observer 2) and the classification error rate (2.2% and 9.2%, respectively) are low. The study then shows that the preauricular groove, as defined by Bruzek (2002), is present in significant proportions in both nulliparous females (73.8%) and females who have given birth (79.8%), and that therefore it cannot be considered an indicator of obstetric history. The number of children does not seem to be an explanatory factor, but age contributes to the shaping of these bony imprints. The preauricular groove is already recognizable in close to 60% of females aged 16 to 39 years, but the bony changes are more marked with increasing age, leading to a decrease in both sex diagnostic error and indeterminacy. Correlation between a hyperfeminine morphology of the pelvis and a highly feminine development of the preauricular area may indicate a biomechanical contribution.

The detection of parturition markers on archaeological pelvic bones is relevant for the reconstruction of the biological profiles of female individuals, in whose life history pregnancy represents a crucial biological event. During a preliminary study on a sample of 18 individuals from the medieval and post-medieval cemetery of San Biagio in Cittiglio (northern Italy), two skeletons exhibited evidence of noteworthy bony projections at the sacroiliac level. In clinical studies, these occurrences can be connected to several biological variables such as age, obesity, and multiple births, suggesting that they are a possible consequence of weight-bearing stresses. Here, we address two cases of accessory sacroiliac joints and the iliosacral complex found in two female individuals. The study is part of the anthropological analysis of the sample from the cemetery of Cittiglio (78 individuals have been investigated to date) and, in particular, of the examination of female and male pelves in order to highlight the expression and aspect of pelvic features in both sexes.

This paper summarizes the history of the study of bone surface depressions near the contact surfaces of the sacroiliac joint, or grooves located below the linea terminalis, known in the literature as "scars of parturition" or "pelvic scars". Since the beginning of the 20^th century, the "sulcus praeauricularis" has been confused with the "sulcus paraglenoidalis" without a satisfactory explanation of their aetiology. Any groove in the preauricular area of the pelvic bone has been referred to as an indicator of female sex and used in sex estimation in a way that does not respect the nature of sex differences. Novotný (1979) included bone structures, which were described by various authors in both females and males, in his method of holistic evaluation. He proposed a three-step categorization for the evaluation of the bone surface of the pelvic preauricular area (three sub-characteristics scored independently) in order to distinguish the sulcus praeauricularis as a female trait from other structures that may occur in both sexes. However, Novotný's work did not become widely known. Testing of the Novotný method was performed in four groups of individuals of known sex without knowledge of the reproductive history of the females (Novotný 1981; Bruzek 2002; Mikešová 2008) and included a total of 852 pelvic bones (457 male and 395 female). The results showed that female morphology, which is characterized by the presence of various forms of sulcus praeauricularis, occurred in a total of 270 of 395 females (68.3%). Female morphology was found in only 5 of 457 males (1.1%). Male morphology was observed in 419 of 457 males (91.7%), but also in 11.1% of females (44 of 395). Indeterminate or ambiguous morphology was found in 33 of 457 males (7.2%) and 81 of 395 females (20.5%). The application of the Novotný method showed that of the total 275 specimens with female morphology, 98.2% were females and only 1.8% were males. It is therefore appropriate to use this reliable method to estimate the sex of skeletal samples. To test the relationship between morphology and obstetric history in females it is necessary to use a sample with known parity.

The sacrum is often used for sex estimation of human remains. However, reported sexual classification accuracies based on the sacrum produce highly discrepant estimates ranging from 54% to 98% depending on the method and reference sample. Here, we therefore aim to evaluate the sacrum's efficacy in differentiating males from females by comparing three different approaches in a homogeneous Central European sample (n = 58, 27 males and 31 females) obtained from the 19th century Weisbach collection. Specifically, we investigated the sacrum by 1) a qualitative visual inspection, 2) traditional linear metrics, namely, sacral width, corpus width, and the associated corporo-basal index, and 3) geometric morphometrics (GM) using a 3D configuration of 100 landmarks and semilandmarks. Classification accuracies for the qualitative approach ranged from 69% to 81%. The investigated quantitative methods based on linear dimensions led to comparable classification accuracies of 62% for sacral width and 78% for the corporo-basal index. However, absolute corpus width had a stronger discriminative power (86%), similar to the PC scores from shape space (87%). Unexpectedly, the GM approach, which considered the shape of the entire sacrum, did not classify better than linear variables. This was exceeded only when sacrum shape was combined with corpus width or another measure of size, like the natural logarithm of the centroid size, yielding a classification accuracy of 95%. The male and female group means differed mainly in the general height-to-width relationship and corpus-to-alae proportions, corroborating patterns previously described in the literature. Our results suggest that the sacrum is markedly less effective than the hipbone for sex determination, which is at odds with its central position within the pelvic girdle and thus its supposed obstetric relevance.

Human males are larger than females in body size; females are larger than males in pelvic size. Percentage pelvic sexual size dimorphism (sex with larger mean/sex with lower mean*100%) is used to infer selection for obstetric adaptation. As pelvic size is associated with body size, interpretation of percentage sexual size dimorphism necessitates control of body size. This study uses a larger sample of 221 females and 204 males to identify a subsample of females and males matched for femoral length, femoral head diameter, and clavicular length (25 females, 46 males). For five measures of the pelvic inlet, the human sample with control of body size is compared with three primate species that are sexually monomorphic in body size and give birth to newborns with higher relative body masses than those of humans: Aotus azarae (15 females, 19 males), Hylobates lar (29 females, 29 males), and Saguinus geoffroyi (28 females, 30 males). Results show that humans (112.0%) have the highest percentage sexual size dimorphism of pelvic inlet circumference: A. azarae (108.2%), H. lar (105.4%), and S. geoffroyi (103.3%). Humans have higher sexual size dimorphism of inlet circumference despite lower relative newborn body mass compared to the other species because human newborns are of larger body mass than predicted for an anthropoid with our adult female body mass. In humans, birthing of bigger babies than predicted for our body mass increases selection pressure on females for enlargement of the pelvic inlet.

Hip dysplasia (DDH) as well as femoroacetabular impingement (FAI) are common causes of hip pain in young adults and lead to premature osteoarthritis (OA). However, not all patients with radiographic features of DDH or FAI develop symptoms and degenerative changes, which indicates that various factors play a role in the disease process. Here we use a diamond concept to illustrate anatomical factors that play a role in the pathomechanism of symptomatic DDH and FAI. This concept may help clinicians in the diagnosis of hip pain in young adults. For DDH, the following factors are included: (1) acetabular and (2) femoral morphology, (3) pelvic shape and geometry, (4) spinopelvic alignment and (5) soft tissue properties. For FAI, the following factors are included: (1) intraarticular acetabular and (2) intraarticular femoral morphology, (3) extraarticular pelvic and (4) extraarticular femoral morphology, (5) spinopelvic alignment and (6) soft tissue properties. Knowledge of these factors can help to identify an adequate treatment. Surgical treatment options include (1) extraarticular acetabular, (2) extraarticular femoral, (3) intraarticular acetabular and (4) intraarticular femoral procedures. Further research is warranted on the specific role and the interaction of the parameters presented in the diamond concept in the disease process of hip joint degeneration.

During the analyses of several hundred prehistoric individuals from Austria, we observed that some women display a "Pelvic Pattern" at the innominate bones and the sacrum, i.e. specific combinations of pronounced expressions of pelvic features. We recorded classic pelvic features (dorsal pubic pitting, preauricular sulcus, extended pubic tubercle) as well as new ones (SPE: sacral preauricular extension, a ventrally pointing flat bone formation at the ventrosuperior margin of the ala ossis sacri; SPN: sacral preauricular notch, a loss of convexity at the same location; CF: corresponding facets at the ilium), and some less well-known features, i.e. the margo auricularis groove, ventral pubic exostoses and lesions. To quantify the assessed features, we developed a specific formula to calculate the 'Pelvic Pattern Index' (PPI). As pregnancies and/or parturitions are suspected to contribute to or be at least partly causative of the occurrence of pelvic features, we analyzed 48 well-preserved female individuals and 15 males from identified skeletal collections with obstetric information in Geneva and London. In these collections, we found a pelvic pattern of at least four out of ten distinctly expressed pelvic features only in multiparous females, but not in nulli- or primiparous females or in males. This pattern was found in 40.6% of the multiparous females and 29.2% of all females from the identified collections, compared to 56.1% of well-preserved prehistoric females with unknown parity status from Austria (n = 41). The mean PPI of the multiparae from the identified collections is 0.25, compared to a mean PPI of 0.19 for all women from the identified collections, and 0.28 for the prehistoric female individuals. We conclude from this that a high PPI (≥ 0.30), especially in cases where SPE or SPN are present, can give insights into past motherhood.

Taphonomic changes can mimic pathological bone lesions and make it difficult to distinguish between ante- and postmortem abnormalities and to perform differential diagnostics. 3D methods, such as CT scanning and 3D printing, can be used as complementary tools to overcome the taphonomic changes. Here, we reconstructed a skull of an interesting archeological case showing severe pathological changes using 3D printing and physical reconstruction. The skeleton belonged to an approximately 18-year-old female. The bones of the entire skeleton exhibited several pathological changes. Both cranium and mandible were asymmetric, with a malformed foramen magnum and left zygomatic process, agenesis of the left external acoustic meatus, cribra orbitalia, and a bilateral absence of mental foramen. The overall diagnostic interpretation was hampered by the extensive taphonomic damage that affected the left side of the skull. In particular, the frontal bone showed taphonomic breakage and plastic deformations were present on the left side of the cranium. The skull was CT-scanned and 3D models of all the single bones were 3D printed and manually re-assembled. The intact reconstructed skull was used to estimate the endocranial volume (ECV). We showed how 3D printing and physical reconstruction of the skull helped overcome the extensive taphonomic alterations; the reconstructed skull provides important diagnostic information such as ECV and a better picture of the original ante-mortem pathological state of the skull.

The present research analyzes the human skeletal remains from Santa Cristina in Caio (Siena, Italy) aiming at reconstructing the demography, and the musculoskeletal stress markers of this Early Medieval Italian population. The cemetery area was recovered during excavation campaigns carried out by the University of Siena between 2013 and 2015 and unearthed 53 individuals dating back to the 6^th-7th centuries CE. The analyzed sample counts 49 individuals: 1 juvenile and 48 adults. Sex-ratio (M:F = 0.95) revealed a slightly higher percentage of females. Both sexes, reached old age so they probably experienced similar life conditions, this is supported by archaeological data that tend to exclude the existence of a class structure within the society. Females show a higher mortality in the young adult age class (19-30 years) probably as a consequence of short-term pregnancies and childbirth. Post-cranial indices and musculoskeletal stress markers revealed a strength physical constitution highlighting statistically significant differences in the degree of biomechanical load the two sexes were subjected to. The goal of the present research was to present the composition of an Early Medieval population from Central Italy that could represent an important tile for understanding the dynamics of a complex historical period.