Orthopedics - Oleksa A.P. 2006

Occupational musculoskeletal disorders
Chronic lead poisoning (saturnism)

Industry utilizes pure lead and A wide variety of its compounds, including lead oxides, red lead, lead chloride, lead iodide, and lead nitrate. Occupational lead poisoning occurs during the extraction and smelting of lead ore, the manufacturing of batteries, white lead, red lead, and other paints, the galvanization of metal parts, as well as in printing and other fields.

Lead poisoning has been known since antiquity as saturnism or plumbism, with some of its clinical symptoms described by Hippocrates as early as 370 BC. In Ancient Rome, lead consumption reached 4 kg per capita annually, which is close to the modern consumption of this element in the USA (6 kg). Lead was primarily used in the construction of aqueducts and Water pipes, and in the tinning of bronze cooking pots to impart a sweet taste. Wines and juices were also produced in lead-coated vessels to enhance their flavor. The widespread domestic use of lead by ancient Romans inevitably led to the contamination of food and beverages with this element. There is even a hypothesis (Gilfillan S.C., 1965) suggesting that the decline of the Roman Empire was largely driven by lead poisoning among its citizens. This view is supported by data showing high lead content in the skeletal remains of Romans, particularly Roman patricians.

The first documented cases of mass lead toxicity date back to the 16th century—specifically in Amsterdam, where the population drank water from lead-contaminated pipes, and in Devonshire, England, where lead-coated presses and vessels were used in cider production. Later, in 1771, the Dutch physician and professor A. de Haen (1704–1776) provided a detailed clinical description of lead-induced paralysis.

Today, lead is attracting heightened interest as a priority environmental pollutant, with annual industrial and transport emissions exceeding 400,000 tons, threatening the health of millions of people, especially children (Nriagu Y.O., 1978; Chisolm J.J. et al., 1985). The absorption of this metal from the digestive tract occurs three times more intensely in children than in adults.

Iron and zinc act as lead antagonists, with zinc specifically reducing the accumulation of lead in bones.

Lead and its compounds enter the body via the respiratory tract in the form of dust and vapor, as well as through the gastrointestinal tract. Even certain water-insoluble lead compounds dissolve readily in gastric juice and are absorbed into the bloodstream. Lead is distributed across all Organs and Tissues and is not fully eliminated from the body, being primarily sequestered (up to 75%) in the bones. In growing organisms, it deposits predominantly in the metaepiphyseal regions of long tubular bones. The earliest signs of lead intoxication manifest in The Nervous system and Blood. Initially, hyperexcitability develops (lead neurasthenia), followed by the depression of the Cerebral Cortex AND subcortical centers, and a decline in analyzer Functions—manifesting as altered taste and smell, and reduced cutaneous sensitivity. Due to lead-induced irritation of the Bone Marrow, the blood shows reticulocytosis (exceeding 12%) and basophilic stippling of erythrocytes, culminating in toxic hypochromic anemia, while lead is detectable in the urine (24 µmol/day).

Early symptoms of poisoning also include the appearance of a blue-gray border along the margins of the Gums in front of the upper and lower Teeth, caused by the precipitation of lead sulfate—formed through the interaction of salivary lead

and hydrogen sulfide. As the intoxication progresses, gastrointestinal disorders emerge—such as lead colic resulting from smooth Muscle spasms, gastritis, and colitis. Interstitial nephritis and nephrosclerosis occasionally develop, accompanied by pathological changes in other Internal Organs. Disorders of the central and peripheral nervous systems progressively worsen (encephalopathy, polyneuritis).

Lead intoxication is often accompanied by Bone and joint pain (arthralgia), which serves as a key diagnostic indicator of saturnism.

Radiological examination of the bones reveals a coarse-meshed restructuring of the trabecular bone within the epimetaphyseal Zones of the upper Tibia, the lower Femur, and the distal forearm bones. Alongside trabecular restructuring, areas of bone resorption and sclerosis are observed. Sclerotic changes involve the epimetaphyses, and endosteal calcification alongside lamellar Structuring of the compact bone may also occur. Notably, however, lead does not accumulate in the bone marrow.

Radiological findings are not pathognomonic; rather, they resemble changes caused by chronic intoxication with other substances (such as cadmium or bismuth), particularly in growing organisms.

S.A. Reinberg points out that lead salts induce profound anatomical and radiological alterations in children's bones that are absent in adults. The primary source of lead entering a child's body consists of lead-based paints (on walls, furniture, and household items), as well as lead dust carried home on parents' work clothing. Lead can also be transmitted to an infant through breast milk.

The primary radiological hallmark is the appearance of a radiopaque band within the bone metaphyses. According to Reinberg, this band is caused not only by the radiopacity of accumulated lead but also by histologically proven trabecular osteosclerosis.

The width and intensity of the transverse metaphyseal band reflect the duration of exposure and The amount of lead accumulated in the bone. Toward the diaphysis, the lead-dense zone transitions into normal Bone Structure. The periosteum is typically spared from these pathological changes.

Following successful Treatment of the poisoning, the "lead band" gradually resolves.

The Prevention of lead poisoning relies on personal protective equipment. Most importantly, this includes strict adherence to personal hygiene, as well as the consumption of Pectins and Eleutherococcus. Adolescents and women are strictly prohibited from working with lead. Preventive measures are regulated by special guidelines issued by the Ministry of Health of Ukraine.