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It's in the Bones

Doctors gain new insights from Hamann-Todd Human Osteological Collection

UH Innovations in Orthopaedics - Fall 2018


Raymond Liu, MD


Pediatric Orthopaedic Surgeon, UH Cleveland Medical Center; Associate Professor, Orthopaedics and Pediatrics, Case Western Reserve University School of Medicine

When researching orthopaedic conditions such as arthritis, 100-year-old bones may not be the first source material that comes to mind.

Raymond Liu, MD, a pediatric orthopaedic surgeon at University Hospitals Rainbow Babies & Children’s Hospital, studied thousands of them to test hypotheses and provide better patient care. His library: the Hamann-Todd Human Osteological Collection.

T. Wingate Todd, MD, an anatomy professor at Western Reserve University (now Case Western Reserve University), and Carl A. Hamann, MD, Dean of Western Reserve University's Medical School, collected human skeletons for the collection between 1912 and 1938.

Dr. Todd and assistants measured, photographed and recorded vital stats for the bodies before embalming and using them in anatomy class. Later, after macerating the bodies, Todd labeled each bone and stored them in pine boxes.

For each body, the researchers documented height, weight, age at death, gender, race, cause of death and more than 70 measurements. They also included photographs and radiographs taken at curation as well as autopsy results.

Now housed at the Cleveland Museum of Natural History, the collection contains more than 3,000 cadaver-derived human skeletons. Dr. Todd's detailed documentation makes the collection an important resource for orthopaedic researchers.

Although the collection is more than a century old, it allows orthopaedic specialists to study anatomy for modern research. "A lot of anatomy hasn't been studied relative to what surgeons do today," Dr. Liu says.

He and his colleagues were able to make several valuable discoveries by working with the bone collection.

Studying 1,152 leg bones, Liu and University Hospitals Cleveland Medical Center resident Douglas Weinberg, MD, found that an abnormal tibia-to-femur ratio may predispose a person to ipsilateral hip and knee arthritis.

“The average ratio of tibia to femur is 0.8,” Dr. Liu says. “If that ratio increases, there's a correlation with increased hip and knee arthritis. Knowing this gives us guidance in treating children with different limb lengths.”

Dr. Liu and a team from Case Western Reserve University School of Medicine and UH Rainbow Babies & Children's Hospital also confirmed that tibial torsion and femoral anteversion — common abnormalities in children — do not predispose them to arthritis. Studying 1,158 tibias and fibulas, the researchers found differences between races and sexes, but no influence on arthritis development.

“We routinely tell parents their children will probably do fine in the future, but it's hard to prove,” Dr. Liu says. “In the collection, we measured how much torsion the bones have versus how much arthritis are in the joints. Now we know long-term consequences are unlikely.”

Dr. Liu recently took an interest in pelvic incidence, the mathematical combination of pelvic tilt and sacral slope. Using a previously validated technique, Dr. Liu and team measured the pelvic incidence of 880 skeletons.

“By studying how pelvic incidence affects the spine and hips, we can postulate whether it influences lower back and hip arthritis,” Dr. Liu says. “The collection gave us an avenue for better understanding of the human body.”

Studying the bones also gave the researchers insight into surgical techniques. "So many surgeries have changed over the years,” Dr. Liu says. “For example, the sagittal plane starting point for trochanteric entry nails had not been well documented. We were able to report that it is generally five millimeters posterior to the tip of the greater trochanter in both adults and children.”

Having close access to the collection also inspires collaboration between UH and other notable health organizations. UH Rainbow Babies & Children's Hospital and Boston Children's Hospital are working together to better understand the cause of Cam impingement, which occurs when the femoral head isn't perfectly round.

“We suspect the condition may come from doing too much activity in adolescence,” Dr. Liu says. “We're using the collection and other data to understand it better.”

Considering the size and scope of the Hamann-Todd Human Osteological Collection, UH research physicians have a tremendous resource in their back yard. "The shape of our skeletons hasn't changed much over the past 100 or even 500 years," says Dr. Liu. "Diseases and what humans do with their bodies has changed. Anatomy does not."


To request access to the Hamann-Todd Osteological Collection, fill out a research request form. Contact Lyman M. Jellema, Collections Manager, at 216-231-4600 x3276 for information.