Age-related features of the pelvic bones. Age-related features of the pelvis

/ Fedorov I.I. // Forensic-medical examination. - M., 1963 - No. 4. — P. 18-25.

Department of Radiology and Medical Radiology (Head - I.I. Fedorov) Chernivtsi Medical Institute

Received by the editors 4/III 1963

Age-related features of the pelvic bones

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Age characteristics pelvic bones / Fedorov I.I. // Forensic-medical examination. - M., 1963. - No. 4. — P. 18-25.

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To determine the age of a person in forensic practice, features of the pelvic bones can be used.

To study the processes of ossification of the pelvis, we mainly used the x-ray method, supplementing it in some cases with anatomical and histological studies.

A total of 630 were examined healthy people(from birth to 25 years), 48 anatomical preparations of the pelvic bones, 40 anatomical preparations of growth zones and 51 histological sections from anatomical preparations of growth zones.

Ilium by the time of birth, it is clearly differentiated radiographically into the body and wing. Its upper edge is arched and has smooth contours, the anterior edge is close to straight, the posterior edge in the area of the posterior superior spine almost touches the lateral edge of the sacrum. The inferior posterior spine and the greater sciatic notch are well defined. The lower edge is angled downward, its sides are straight and smooth (Fig. 1).

By the end of the first year of life, unevenness of the upper edge of the bone is revealed. In children 2-3 years old, this unevenness takes the form of a clearly defined jaggedness or “saw” (see Fig. 5, 1). It is most clearly detected at the age of 13-16. By the age of 19-25, with the onset of synostosis of the crest with the ilium, the irregularity disappears.

Rice. 1. X-ray of the pelvis of a newborn girl.

At microscopic examination it turned out that the irregularities represent a zone of preparatory calcification of cartilage with its uneven resorption and replacement bone tissue.

The lower anterior spine develops from an accessory ossification nucleus, detected on radiographs from 12-14 years of age. Synostosis of the inferior spine with the ilium occurs in girls at 14-16 years of age, and in boys - at 15-18 years of age.

The accessory ossification nucleus of the iliac crest is first noted on radiographs of the pelvis of girls aged 13-15 years, and in boys aged 15-18 years (Table 1). In the first 2-3 years after its appearance, the crest core consists of several “ossification points” (Fig. 2), which later merge into one continuous, smoothly curved strip, wider in the middle third and gradually tapering towards the anterior and posterior edges of the ilium. , spreading to its anterior and posterior spines. The lower contour of the ridge can also be uneven.

Synostosis of the iliac crest begins with leading edge wing and gradually spreads to its middle and posterior thirds.

Synostosis of the ridge along its entire length was first noted at the age of 19. By the age of 22, synostosis of the iliac crest is observed in all men, while in women it is observed only at the age of 25 (Table 2). By the time the crest synostoses with the ilium, its formation is completed.

Ischium at the time of birth, on radiographs it is represented by one upper branch (see Fig. 1). The lower branch begins to form from 4-5 months of life and is not clearly expressed until the end of the year. At 2 years of age, the ischium is already represented by both developed branches.

Table 1

The period of appearance of additional ossification nuclei of the ilium, ischium and pubic bones

Age (in years)	Number of studied		Presence of ossification nuclei
	Number of studied		iliac crest		apophysis of the ischium		apophysis of the inferior ramus of the pubic bone
	m.	and.	m.	and.	m.	and.	m.	and.
			-		-	-	-	-

Rice. 2. X-ray of the pelvis of a 15-year-old girl.

1 - ossification nuclei of the iliac crest; 2 - apophysis of the ischium; 3 - accessory ossification nucleus of the anterior inferior iliac spine.

The ischium does not have an independent ossification point and is formed from the primary nucleus of the ischium. For the first time it begins to appear on radiographs from 7-8 months of age, but by the end of the first year of life it is still poorly expressed. By the age of 10-12 years, the ischium reaches a size of 10-15 mm, its apex has unclear contours and is rounded. By the age of 13-17 the top. the bones are already clearly contoured; In about half of those studied, it appears flat, as if cut off, while in the other half it is rounded.

The accessory ossification nucleus of the apophysis of the ischium first appears at 13-17 years of age in girls, and at 15-19 years of age in boys (see Table 1, Fig. 3). In the first 2-3 years after its appearance, the apophysis consists of multiple “ossification points”, which later, gradually lengthening, merge into one continuous strip, separated from the ischium by a barely noticeable clearing. Synostosis of the apophysis with the bone also begins with the upper branch and gradually spreads to the lower branch; complete synostosis in men is observed at 19-22 years of age, in women - 2-3 years later (Table 3). Synostosis with the lower branch of the pubic bone in isolated cases is observed at 3 years of age, regardless of gender. The area of synostosis appears thickened in the form of a callus, the contours of the thickening are uneven and unclear, and the bone pattern is uniform. All this suggests that the process of synostosis is not yet completed. At 3-5 years of age, only incomplete synostosis is observed. Complete synostosis of the lower ramus of the ischium with the lower ramus of the pubic bone is observed in isolated cases in girls aged 6 years, and in boys aged 8 years. Synostosis does not always occur symmetrically on both sides. At the age of 12, synostosis is observed in all boys. The area of synostosis in approximately half of all those studied, even after the final formation of the ischium, remains thickened in the form of a bone callus, but unlike the latter, the thickening has clear contours and a normal bone pattern.

table 2

Period of synostosis of the iliac crest

Age (in years)	Number of studies	No synostosis	Incomplete synostosis	Complete synostosis
Age (in years)

Rice. 3. X-ray of the symphysis region of a 19-year-old young man.
1 - apophysis of the ischium; 2 - apophysis of the lower branch of the pubic bone.

Table 3

Period of synostosis of the apophysis of the ischium

Age (in years)	Number of studies	No synostosis	Incomplete synostosis	Complete synostosis
Age (in years)

Rice. 4. X-ray of an anatomical specimen of the pubic bones in the symphysis region of a 13-year-old boy.
1 - the serration (“saw”) of the pubic bones is clearly visible.

The final formation of the ischium in men ends at 19-22 years, in women - at 21-25 years.

pubic bone at the time of birth, on the radiographs of all those studied, it was represented by one upper branch, located obliquely (see Fig. 1).

The lower branch begins to form from the 2nd month of life. In all 6-8 month old children, the lower branch is already clearly expressed. The contours of the upper branch in the area of the symphysis and acetabulum in the first 1-2 years are smooth and rounded. At the 3rd year, uneven contours are revealed, which by 4-6 years takes on the appearance of a “saw” or waviness and histologically represents a zone of calcification of cartilage with its uneven resorption and replacement by bone tissue; here the growth of the upper branch of the pubic bone occurs in length.

Table 4

The wavy contours are more clearly visible at the age of 13-16, during the most rapid bone growth (Fig. 4); it disappears in girls at the 13-15th year of life, in boys - at the 15-18th year. With the disappearance of the undulation, the growth of the superior branch of the pubic bone stops. The anterior tubercle of the obturator foramen is formed by the primary ossification nucleus of the superior ramus of the pubis. Radiologically, the tubercle first begins to appear at 7-9 years of age. From 13-16 years of age, it is visible in approximately 25% of those studied. The accessory ossification nucleus of the apophysis of the lower branch appears at 19-22 years of age (see Table 1). In the first 1-2 years after its appearance, the apophysis consists of several “ossification points”, which later merge into one narrow strip(see Fig. 3). Synostosis of the apophysis with the lower branch and the formation of the pubic bone are observed in men 22-23 years old, in women 22-25 years old (Table 4).

acetabulum by the time of birth and in the first months of a child’s life, it consists of cartilaginous tissue and is represented by a wide clearing limited by the ilium, ischium and pubic bones (see Fig. 1). The contours of these bones in the area of the acetabulum are smooth until 6-7 months of life. From 8-9 months there is a slight unevenness of the upper contour of the acetabulum, and from 3 years of age - unevenness of the acetabulum in the area of the anterior and posterior contour, which by 4-6 years takes on the appearance of waviness (Fig. 5, 3). Histological studies of G.P. Nazarishvili and our team showed that the uneven contours of the cavity are due to uneven growth of bone substance due to articular cartilage. The wavy contours are most pronounced during puberty, when the most intensive growth of the pelvic bones is noted. With the onset of synostosis of the bones forming the acetabulum and the cessation of their growth, the waviness of the contours disappears.

Rice. 5. X-ray of the pelvis of a 4-year-old boy.

1 - unevenness of the upper edge of the ilium; 2 - thickening of the area of synostosis of the lower branches; 3-irregularity of the contours of the acetabulum; 4 - “figure of a tear”; 5 - “crescent figure”.

In 7-8 month old children over upper contour of the acetabulum, in the area of its roof, a compaction of bone substance with very delicate short transversely located bone beams appears. In the majority of children studied, at the age of one year, the layer of compaction of the bone substance above the roof is 0.5 cm, and in some cases reaches 1 cm. By the age of 18-19 years, the thickness of the roof of the acetabulum is 4-6 cm, regardless of gender.

The compact bone substance of the acetabulum fossa first begins to appear on radiographs in children at 2 years of age in the form of a gentle spherical shadow. At the same time, compact bone substance begins to appear. medial surface body of the ischium in the form of a straight vertical strip. Both described stripes run almost parallel to each other. At 3 years of age, a third short, smoothly rounded strip of compact bone substance appears at the lower edge of the acetabulum notch, closing the lower ends of the two strips described above. From the moment of their fusion, a radiographic formation of the acetabulum is created in the form of a “tear-shaped figure” (A. Köhler, V.S. Maykova-Stroganova). From the age of 4-5 years of life, the “tear figure” is observed in all those studied (see Fig. 5, 4).

In 2-year-old children, along the lower part of the posterior edge of the acetabulum, a “crescent figure” begins to appear in the form of a gentle, smoothly rounded short shadow, convexly facing outward. At the age of 3, the “crescent figure” is observed in half of the studied, and from 5-6 years old - in all (see Fig. 5, 5).

Rice. 6. X-ray of the pelvis of a 14-year-old boy.

By the age of 7-9 years, the “acetabulum bones”, located between the ilium and pubic bones, begin to be identified for the first time. The shape of the bones is irregular, elongated, size 2-4 mm in width and 10-12 mm in length. More often one or two such bones are visible symmetrically on both sides, less often on one side. At the age of 10-12 years, “acetabulum bones” are observed in almost all children. By the time of synostosis, their shape remains irregular, elongated, their size increases to 3-6 mm in width and up to 10-15 mm in length.

Table 5

With the completion of synostosis of the bones forming the acetabulum, the “ossicles of the acetabulum” are not detected.

At 12-13 years of age, the third additional bone formation- “epiphysis of the acetabulum.” By the time of synostosis of the bones forming the acetabulum, this bone is observed in the majority of those studied (Fig. 6).

Synostosis of the bones forming the acetabulum is observed in isolated cases on radiographs of the pelvis of 13-year-old girls. At the age of 14, synostosis is observed in the majority of girls; at the age of 15, in all girls. Synostosis of these bones in young men begins accordingly 2-3 years later (Table 5). By the age of 18-19 years, the acetabulum appears radiographically to be fully formed.

conclusions

The pubic bone has an apophysis of the lower branch, the additional ossification nucleus of which appears at 19-22 years of age, regardless of gender. Synostosis of the apophysis with the lower branch occurs at 22-23 years in men, and at 22-25 years in women.
Accessory nuclei of ossification of the iliac crest and apophysis of the ischium appear in girls at 13-15 years of age, in boys - at 15-18 years of age. Synostosis of these apophyses, according to our observations, occurs in men at 19-22 years of age, in women - at 19-25 years of age. However, this issue can be finally resolved only by studying significantly more observations of persons aged 22-25 years.
Synostosis of the lower branches of the ischium and pubic bones is observed in girls aged 6-12 years, in boys - 8-15 years, incomplete synostosis - from 3 years of age, regardless of gender.
The accessory ossification nucleus of the anterior inferior iliac spine appears at 12-14 years of age, regardless of gender. Its synostosis with the ilium occurs in girls at 14-16 years old, in boys - at 15-18 years old.
Synostosis of the bones forming the acetabulum occurs in girls at 13-15 years old, in boys - at 15-17 years old.

The pelvis is the supporting link that connects the upper and lower parts of the body. It supports the spine and allows the torso and lower limbs to move in a coordinated manner. With its help, a uniform redistribution of all load vectors occurs. A twisted pelvis causes deformation spinal column. This phenomenon has a number of dangerous complications.

Causes of pelvic displacement in children

Various triggers can provoke pelvic curvature. Among the most common disease factors in children are:

Muscle imbalance. Occurs in the absence of adequate physical activity, with a dominant sedentary lifestyle. Such phenomena lead to the fact that a certain group of muscles in a child gradually weakens (in bedridden patients it can completely atrophy), while other ligaments are in constant voltage. The main function of the muscular pelvis is to maintain the normal anatomical position of the musculoskeletal system. If one group of ligaments is relaxed and does not work, and the other is tense and constantly in good shape, the pelvis moves.
Bone injury. Children are very active. They often fall during games. Bone fractures accompanied by a rupture of the pelvic ring take a long time to heal. If the child was provided with unqualified health care, the healing of fractures occurs incorrectly, and this often leads to disruption of the shape of the joint and to further curvature of the pelvis.
Muscle ruptures. Damage to any ligament leads to the formation of tension and displacement of healthy tissues relative to each other. The immobility of the joints is disrupted. If the ligaments are not restored, the pelvic bones will inevitably shift over time. This pathology can develop in different ways. If the muscular lower back is damaged, the pelvis moves forward. A quadriceps tear causes hip flexion. Injury to the adductor muscles tilts the most big bone V human body forward and turns the thigh inward.
High physical activity. Such risks are always present in children's sports if training is carried out without the supervision of an experienced and competent instructor. They occur when a child often carries a heavy musical instrument or a bag filled to the brim with books.
Anatomical features. Children who have had rickets develop a flat-rachitic pelvis. The wings of the ilium are turned forward, the distance between their highest points is increased. In this case, the sacrum shortens, flattens and rotates around a horizontal axis. In particular severe cases it is possible to change the position of all the bones of the largest joint. This can lead to mixed deformities.
Complications that occurred after past diseases. Dysplasia missed in childhood leads to a difference in length lower limbs. Most often, with this pathology, asymmetry of the pelvis occurs, which forms a skew from right to left or from front to back (back to front). In this situation, twisting of the main support unit often occurs. A flat pelvis is a consequence of previous rickets or polio.
Surgical operations. Any surgical interventions in the area of the pelvic bones may be complicated by rotation of the described structure.

Anteversion is also affected by scoliotic changes (congenital or acquired) that form in the lower lumbar region.

Symptoms and signs

The pathology has no characteristic manifestations. An experienced doctor can recognize it by a combination of indirect signs:

pain that occurs only when walking or running;
any discomfort in the lumbar region, hips, in the projection of the sacroiliac joints, in the groin, knee joint, ankle, foot or Achilles tendon;
stiffness of movements;
frequent falls;
unsteadiness in gait;
the appearance of a difference in the length of the lower limbs;
Corns form on the feet, they are more pronounced on the side of the distortion;
sleep is possible only while lying on your stomach or side;
the line of the nose is sloping - one nostril is higher than the other;
the navel moves;
bladder dysfunction;
intestinal disorders.

To identify the exact cause of the malaise, a specialized examination is necessary.

Diagnostics

For help, you need to contact a surgeon, traumatologist or orthopedist. At the first stage, the doctor collects an anamnesis based on the patient’s complaints, then palpates the painful areas. After analyzing the first data, an instrumental examination is prescribed:

radiography of the spine and pelvic bones;
CT or MRI of the painful area.

Decoding the obtained data allows you to make an accurate diagnosis.

Therapy methods

It is impossible to treat the symptoms of pathology without eliminating the cause of the illness. If it is possible to do without surgical intervention, the patient is prescribed:

manual therapy;
massotherapy;
physiotherapy.

Manual therapy in children is carried out without sharp traction. The massage starts with thoracic spine, then gradually the specialist lowers himself to the lower back. Uses movements to help shoot muscle spasm, eliminate existing cartilage infringements. The vector of efforts is constantly changing. If necessary, the doctor can apply force aimed at realigning the affected segment.

Opportunity to achieve therapeutic effect depends largely on the qualifications of the massage therapist. This should be a specialist with a medical diploma and experience working with sick children.

Doctors recommend performing exercise therapy from the first day of diagnosis. This is especially important when pelvic displacement occurs in adolescents due to scoliosis. The doctor himself should advise which exercises can be used and which cannot. Initiatives are unacceptable: there may be a bias in different sides, this indicator is taken into account when drawing up an activity program. There is a base of exercises that is used to create an individual complex. It includes the following types movements:

Feet shoulder-width apart, feet pressed into the floor, stand on your toes and raise one hip. Then to the starting position.
Hands on your waist, swing your hips to the right, left, twist them in a circle, try to draw a figure eight with them.
Feet shoulder-width apart, feet pressed firmly to the floor, tilt the torso and try to reach your toes with your fingers. If it doesn’t work out right away, we rock the body and try to increase the amplitude of the tilt until we can achieve the goal. At the same time, be sure to ensure that the pelvis does not tilt backward. Then we take the starting position and bend back. We repeat ten times.
We move our legs towards each other, stand up straight so that rib cage, the pelvis and feet were on the same line. Hands along the body. We bend forward, mentally imagining that the body is sandwiched between two high walls. They limit movement, so bending is constrained.
The same starting position, we place our hands on our hips, tilt our body and pelvis to the side, and make an effort with our hands in the opposite direction.
We stand up straight, hands behind our heads, palms pressed closely together, elbows open to the sides, squat, but not all the way, form an angle of 90 degrees, look forward, count to ourselves to five and return to the starting position.

All exercises must be performed carefully, without sudden movements, and with great care. If pain in the pelvis appears, you should immediately stop gymnastics and inform your doctor about it. If there is no discomfort, experts recommend gradually increasing the load and completing each type up to twenty times.

Physiotherapy for pelvic displacement increases blood supply, eliminates pain and signs of inflammation. This treatment allows you to correctly distribute the load on the muscles and stimulate those ligaments that weaken and atrophy. For these purposes, electrophoresis, UHF, magnetic influence, thermotherapy and mud therapy are used.

In the presence of severe syndrome, the patient is recommended to take analgesics and apply to the painful area medicinal ointments. Symptoms inflammatory process treated with non-steroidal anti-inflammatory drugs. Therapeutic measures must be appropriate for the child's age.

Possible complications and consequences

Any displacement of the pelvis, even the slightest, can provoke curvature of the spine and disruption of its function. The described phenomenon leads to a change in the axis and to incorrect distribution of the load inside the column. As a result, excess pressure is formed on certain points. In these places, gradual destruction of bones occurs, and intervertebral hernia, deforming osteoarthritis, spinal canal stenosis, and radiculitis develop. Spinal diseases contribute to the appearance of pain in the back, shoulders, and neck.

Some patients experience the occurrence of carpal tunnel syndrome. An oblique pelvis causes a shift in the center of gravity. The main load begins to act on one leg. This causes lameness.

Preventive measures

To prevent deformation and relieve existing symptoms of pelvic distortion, experts recommend:

swim more;
engage in horse riding;
train the muscles that hold the spinal column;
strengthen the pelvic floor ligaments;
to live an active lifestyle;
do exercises in the morning.

Any classes should be conducted under the guidance of specialists. Prevention of spinal curvature plays an important role in preventing pelvic rotation in children. From an early age it is useful to teach a child to sleep on a hard bed, maintain good posture, eat right, and love sports.

Forecast

Treatment of the described pathology is problematic - it takes time, and the duration of the course largely depends on the severity of the pelvic deformity and the dysfunctions that it could provoke. Achieve positive results difficult. During the existence of the problem, a person develops an incorrect pattern of movements: recovery is hampered by the muscles that, in contrast to the pelvic distortion, create a block of ligamentous groups that try to eliminate this displacement through reflex tension. Only correctly selected treatment and strict adherence to doctors’ recommendations can count on favorable prognoses.

Fractures of the pelvic bones occur most often between the ages of 8 and 12 years - when the ligamentous apparatus is not yet sufficiently developed, there are elastic cartilage layers, and the muscles are already strong. Fractures of the pelvic bones in children are always easier than in adults. So, if in car accident In an adult, the iliac bones break vertically on both sides, while in a child, the iliosacral joint is torn on one side. Subperiosteal fractures occur most easily when the periosteum remains intact and only the cortical layer is torn. Traumatologists compare this condition to a green branch or willow twig, when only fixation and rest are required for recovery and fusion.

The condition of a pelvic fracture in children develops after a car injury, a fall from a height or intense physical activity - a sharp start, doing the splits, taking off when jumping or strong impact on the ball. One or more signs are noted:

Sharp pain;
Edema and swelling;
Subcutaneous hematoma or abrasions;
Forced body position - frog pose or legs bent at the knees and spread to the sides;
It is impossible to lift an outstretched leg;
Unable to urinate or there is blood in the urine;
Painful shock or loss of consciousness.

First aid

If there is at least one symptom, you should consult a doctor immediately.

Important: Before the ambulance arrives, place the child on a backboard or any hard surface to prevent further displacement of the fragments. You can place a small cushion of clothing or towels under your knees. In cold weather, cover with a couple of blankets. Don’t fuss or panic; you can’t do anything on your own. It is forbidden to attempt to stand or sit down.

Classification of pelvic fractures

The diagnosis of a fracture in children is made after full examination, an x-ray examination is performed urgently in the emergency room. If everything is not clear to the doctor, magnetic resonance imaging or CT scan. For fractures in children, these studies are performed on the day of admission. For such studies, anesthesia is sometimes used because the child must be motionless.

See also:

Children are classified following fractures pelvic bones:

Margins of individual bones when an attached muscle tears off the extreme portion. The entire pelvic ring remains intact;
Rupture of the pelvic ring - anterior or posterior:
Anterior - pubic or ischial bones, rupture of the pubis. Sometimes these injuries are combined;
Posterior - iliac or sacral bones or their articulation, as well as double fractures;
Acetabular cavity;
Fracture combined with dislocation.

Modern diagnostic equipment makes it possible to determine the exact location and nature of fractures immediately after their occurrence. If the pelvic ring remains intact, the fracture is called stable; if it is torn, it is called unstable.

Be sure to read:

More often than others, fractures occur when there is a slight displacement in one plane. When a fracture occurs in children, the spongy substance is destroyed more severely than the compact substance. The fracture line is located at the junction of bone and cartilage and is difficult to see on an x-ray.

What happens during various fractures?

First of all, what matters is whether the child has an open or closed fracture. An open fracture is a violation of the integrity of not only bones, but also muscles, ligaments and skin. When closed from the outside, only a hematoma is visible - a bruise or abrasion. Open fractures are more severe because the wound always gets infected from the environment.

The easiest fractures of the pelvis are marginal - these are direct or avulsion fracture ischium or pubis. With well-developed muscles, the fragment can move a considerable distance.

Violation of the integrity of the pelvic ring is dangerous for two reasons:

Internal organs may be damaged;
The deformity that occurs after healing disrupts posture and gait, and in girls, the developing birth canal, which makes spontaneous childbirth impossible in the future.

These fractures require the closest attention and careful reduction or comparison of fragments. Damage can be single or multiple, when the bones are torn into fragments like a butterfly. The most difficult case is a double pelvic fracture in children, when the anterior and rear end rings. The inner part of the pubic bone moves downward, and the outer part moves upward. This condition is named after Malgen, the doctor who first described the mechanism of displacement.

In the acetabulum - the place where the head enters femur– the edge or bottom breaks. If the bottom is damaged, the central one necessarily occurs, the head comes out of the joint fossa.

Fracture dislocation is most often found after falls.

Treatment

Be sure to read:

Children's periosteum is much thicker than that of adults. It is durable and very flexible, it contains a large number of blood vessels- this creates the preconditions for rapid fusion. At the ends of tubular and flat bones in children there are growth zones and elastic growth cartilage. All this softens and absorbs the force of impact. In children organic matter more than mineral ones, so bones are flexible and can withstand significant loads. The characteristics of the body are the basis for the fact that pelvic bone fractures in children heal 3–4 times faster than in adults.

Treatment depends on the location and severity of the injury. There are 2 main methods:

Conservative – immobilization plaster cast or skeletal traction;
Operational.

Treated conservatively marginal fractures pelvic bones in children, as well as those cases when the pelvic ring remains intact. Sometimes even a torn fragment removed a considerable distance can be returned to its place by skeletal traction - this is decided individually, age and muscle strength matter. Dislocations can also be treated without surgery.

Surgical treatment is always necessary when the geometry of the pelvic ring is disrupted. The best results are obtained by metal osteosynthesis or joining bone fragments with metal plates. Surgery is also necessary when the bone is fragmented and the blood supply to small fragments is disrupted. Such fragments must be removed.

Rehabilitation

Sex differences in bony pelvis are already evident in a newborn child, whose formed pelvis contains copious amounts cartilage between the centers of ossification and in their circumference. The pelvis of a newborn girl is lower and wider than the pelvis of a newborn boy, which is expressed relatively large size diameter of the pelvic inlet. The pubic arch of a newborn girl is also somewhat wider than that of a boy.

IN general research pelvis in newborn children showed completely different ratios in the size and shape of the pelvis in different sexes. In addition to the degree of ossification, the newborn pelvis differs in many ways from the adult pelvis. The sacrum with its relatively narrow wings here has an almost straight surface from top to bottom, and the place of its articulation with the last lumbar vertebra, located high above the entrance to the pelvis, only protrudes slightly in the form of a promontory (promontorium). The anterior surface of the sacrum in both horizontal and vertical directions is devoid of concavity. The tailbone is curved slightly forward. Curvature of the spinal column in the lumbar and chest areas in accordance with the absence of sacral curvature, it is insignificant. The iliac bones, located almost vertically, rise steeply upward and have only a slightly concave inner surface.

The shape of the child's pelvis, along with embryonic moments and growth energy, is influenced primarily by the pressure produced from the spinal column when sitting, standing and walking, counterpressure from the lower extremities associated with the pelvic ring in hip joints, as well as the pressure exerted by the iliac bones on the pubic symphysis.

Physiological kyphosis of the thoracic spine results in compensatory curvature of the lumbar part (lumbar lordosis) and, in addition, causes the rotation of the sacrum around its horizontal axis, with the promontory moving down and forward under pressure from the body. The apex of the sacrum, held in its lower parts by strong cords of the spinosacral and tuberosacral ligaments, cannot move back, which is why the entire sacrum must sometimes bend around its horizontal axis and, as a result, becomes concave in front. The sacral vertebrae are most strongly compressed in the back and are lower here than in the front.

If there is no burden from the spinal column, for example, when lying on the back for a long time, then the pelvis acquires features characteristic of the pelvis of a newborn. Under the influence of such factors, physiological curvatures of the spinal column and sacrum can be smoothed out, as well as increased tension in the pelvis in the transverse direction (recumbent pelvis). If, further, there is no counter-pressure from the hips in conjunction with the existing pressure from the spinal column, then the opportunity for the pelvis to expand in the transverse direction becomes disproportionately large. In the absence of a strong connection between the pelvic bones at the symphysis (split pelvis), the pelvic ring should gape widely in front.

Since the posterior ends of the iliac bones are connected to the sacrum by strong ligaments and, with a strong displacement of the promontory forward, must follow the movements of the sacrum, due to this the femurs acquire a tendency to diverge from one another and, as it were, tear the pelvic ring at the symphysis. As the symphysis resists the possibility of this rupture, it is also pulled back. Thus, the stretching of the pelvis in the transverse direction increases, while anterior-posterior size the pelvic ring decreases accordingly. As a result, the pelvic entrance takes on a typical transverse oval shape with a promontory protruding from behind.

So, characteristic changes pelvis of the newborn consist of rotation and flexion of the sacrum, increasing the transverse and decreasing straight sizes pelvis

If the pressure exerted by the torso is very significant, and the pelvis is too pliable due to the elasticity and softness of its walls, then with excessive transverse tension a narrowed pelvis is formed, the so-called flat pelvis. Similar to the emergence of such a pelvis, one can generally easily imagine the emergence of all sorts of narrow pelvises, and also trace the entire process of transformation of the pelvis of the fetus and child into a sexually mature pelvis.

If you are just planning a child, then modern medicine at the earliest stages allows for PGD - preimplantation genetic diagnostics. This diagnosis will make it possible to identify many deviations at the gene level in the very initial period of embryo development.

At the time of birth, the skull is represented by a large number of bones connected by wide cartilaginous and connective tissue layers. The sutures between the bones of the vault (sagittal, coronoid, occipital) are not formed and begin to close only from the 3-4th month of life. The edges of the bones are smooth, teeth are formed only in the 3rd year of a child’s life. The formation of sutures between the bones of the skull ends by 3-5 years of life. The seams begin to heal after 20-30 years.

Fontana of a newborn's skull

Most characteristic feature skull of a newborn - the presence of fontanelles (non-ossified membranous areas of the cranial vault), due to which the skull is very elastic, its shape can change during the passage of the fetal head through the birth canal.

The large fontanel is located at the intersection of the coronal and sagittal sutures. Its dimensions range from 1.5x2 cm to 3x3 cm when measured between the edges of the bones. The large fontanelle usually closes by the age of 1-1.5 years (at present, often already by the 9th - 10th month of life).

The small fontanel is located between the occipital and parietal bones; at the time of birth it is closed in 3/4 of healthy full-term children, and in the rest it closes by the end of the 1-2nd month of life.

The lateral fontanelles (anterior sphenoid and posterior mastoid) in full-term infants are closed at birth.

The structure of the newborn's skull

Brain department The volume of the skull is significantly larger than the facial one (in a newborn it is 8 times, and in adults only 2 times). The newborn's eye sockets are wide, the frontal bone consists of two halves, the brow ridges are not pronounced, frontal sinus not formed. The jaws are underdeveloped, the lower jaw consists of two halves.

The skull grows rapidly until the age of 7 years. In the first year of life, a rapid and uniform increase in the size of the skull occurs, the thickness of the bones increases 3 times, and the structure of the bones of the cranial vault is formed. At the age of 1 to 3 years, the ossification points merge, cartilage tissue gradually replaced by bone. At the 12th year the halves grow together lower jaw, in the 2nd - 3rd year, due to the strengthening of the function of the masticatory muscles and the completion of the eruption of baby teeth, the growth of the facial skull increases. From 3 to 7 years, the base of the skull grows most actively, and by 7 years its growth in length basically ends. At the age of 7-13 years, the skull grows more slowly and evenly. At this time, the fusion of individual parts of the skull bones is completed. At the age of 13-20 years, predominantly the facial part of the skull grows, and sexual differences appear. Thickening and pneumatization of bones occur, which leads to a decrease in their mass.

Infant's spine

The length of the spinal column in a newborn is 40% of the length of his body and doubles in the first 2 years of life. However, different parts of the spinal column grow unevenly; for example, in the first year of life the most rapid growth occurs. lumbar region, slowest - coccygeal.

In newborns, the vertebral bodies, as well as the transverse and spinous processes, are relatively poorly developed, intervertebral discs relatively thicker than in adults, they are better supplied with blood.

The spine of a newborn has the appearance of a gentle arch, concave in front. Physiological curves begin to form only from 3-4 months. Cervical lordosis forms after the child begins to hold his head up. When the child begins to sit (5-6 months), thoracic kyphosis appears. Lumbar lordosis begins to form after 6-7 months, when the child begins to sit, and intensifies after 9-12 months, when the child begins to stand and walk. At the same time, compensatory sacral kyphosis is formed. The curves of the spinal column become clearly visible by the age of 5-6 years. The final formation of cervical lordosis and thoracic kyphosis ends by age 7, and lumbar lordosis- by the period of puberty. Thanks to the bends, the elasticity of the spinal column increases, shocks and shocks when walking, jumping, etc. are softened.

Due to the incomplete formation of the spine and poor development of the muscles that fix the spine, children easily develop pathological curves of the spine (for example, scoliosis) and poor posture.

Child's chest

The chest of a newborn has a cone-shaped shape, its anterior-posterior size is larger than the transverse one. The ribs extend from the spine at almost a right angle and are located horizontally. The chest seems to be in the position of maximum inspiration.

Ribs in children early age soft, pliable, easily bend and spring when pressed. The depth of inspiration is provided mainly by excursions of the diaphragm, the attachment point of which, when breathing is difficult, is retracted, forming a temporary or permanent Harrison's groove.

When the child begins to walk, the sternum drops and the ribs gradually take on an inclined position. By 3 years of age, anterior-posterior and transverse dimensions the chest is compared in size, the angle of inclination of the ribs increases, and costal breathing becomes effective.

TO school age the chest flattens, depending on the body type, one of its three shapes begins to form: conical, flat or cylindrical. By the age of 12, the chest moves to the position of maximum exhalation. Only by the age of 17-20 does the chest acquire its final shape.

Pelvic bones in a child

The pelvic bones of young children are relatively small. The shape of the pelvis resembles a funnel. The pelvic bones grow most intensively during the first 6 years, and in girls, in addition, in puberty. Changes in the shape and size of the pelvis occur under the influence of the weight of the body and organs abdominal cavity, under the influence of muscles and the influence of sex hormones. The difference in the shape of the pelvis in boys and girls becomes noticeable after 9 years: boys have a higher and narrower pelvis than girls.

Until 12-14 years of age, the pelvic bone consists of 3 separate bones connected by cartilage, the fused bodies of which form the acetabulum. The acetabulum in a newborn is oval, its depth is much less than in an adult, as a result of which most of the head of the femur is located outside it. The articular capsule is thin, the ischiofemoral ligament is not formed. Gradually with growth pelvic bone in thickness and by forming the edge of the acetabulum, the head of the femur is immersed deeper into the joint cavity.

Limbs in children

Newborns have relatively short limbs. Subsequently, the lower limbs grow faster and become longer than the upper ones. The highest growth rate of the lower extremities occurs in boys at the age of 12-15 years, in girls at the age of 13-14 years.

A newborn and a child of the first year of life have a flat foot. The line of the transverse tarsal joint is almost straight (in an adult it is S-shaped). Formation of articular surfaces, ligamentous apparatus and arches of the foot occurs gradually, after the child begins to stand and walk and as the bones of the foot ossify.

Children's teeth

Milk teeth in children usually erupt from the age of 5-7 months in a certain sequence, while the teeth of the same name on the right and left halves of the jaw appear simultaneously. The order of eruption of baby teeth is as follows: 2 internal lower and 2 internal upper incisors, and then 2 external upper and 2 external lower incisors (8 incisors by one year), at the age of 12-15 months - anterior molars, at 18-20 months - canines, at 22-24 months - rear molars. Thus, by the age of 2, a child has 20 baby teeth. To roughly determine the proper number of baby teeth, you can use the following formula:

where: X - number of baby teeth; n is the child’s age in months.

Replacing baby teeth with permanent ones

The period of replacement of milk teeth with permanent ones is called the period of mixed dentition. Permanent tooth Usually erupts 3-4 months after the milk falls out. The formation of both primary and permanent dentition in children is a criterion for the child’s biological maturation (dental age).

In the first period (from eruption to 3-3.5 years), the teeth are closely spaced, the bite is orthognathic ( upper teeth cover the lower ones by one third) due to insufficient development of the lower jaw, there is no wear of the teeth.

In the second period (from 3 to 6 years), the bite becomes straight, physiological gaps appear between the milk teeth (as preparation for the eruption of permanent, wider teeth) and their wear.

The replacement of baby teeth with permanent ones begins at the age of 5 years. Teething order permanent teeth usually the following: at 5 - 7 years, the first molars (large molars) erupt, at 7 - 8 years - internal incisors, at 8 - 9 years - external incisors, at 10 - 11 years - anterior premolars, at 11 - 12 years - posterior premolars and canines, at 10 - 14 years old second molars, at 18 - 25 years old - wisdom teeth (may be absent). To roughly estimate the number of permanent teeth, you can use the formula:

where: X is the number of permanent teeth, n is the child’s age in years.

Teething symptoms

In some children, teething may be accompanied by an increase in body temperature, sleep disturbance, diarrhea, etc. The formation of both primary and permanent dentition in children is important indicator biological maturation of the child. The permanent dentition should normally be orthognathic or straight.