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

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

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

Received by the editors 4 / III 1963

Age features of the pelvic bones

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Age features pelvic bones / Fedorov I.I. // Forensic-medical examination. - M., 1963. - No. 4. - S. 18-25.

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

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

In total, 630 healthy people(from birth to 25 years), 48 anatomical preparations of 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 arcuate and has smooth contours, the anterior one is close to straight, the posterior one in the region of the posterior superior spine is almost in contact with the lateral edge of the sacrum. The lower posterior spine and the greater ischial notch are well defined. The lower edge is angled down, its sides are straight and smooth (Fig. 1).

By the end of the first year of life, an unevenness of the upper edge of the bone is revealed. In children 2-3 years old, this unevenness takes the form of a pronounced serration or "saw" (see Fig. 5, 1). It is most clearly revealed at the age of 13-16. By the age of 19-25, with the onset of synostosis of the ridge with the ilium, the unevenness 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 preparative calcification of the cartilage with its uneven resorption and replacement bone tissue.

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

The accessory nucleus of ossification of the iliac crest is observed for the first time on the pelvic radiographs of 13-15 year old girls and 15-18 year old boys (Table 1). In the first 2-3 years after the appearance of the crest nucleus 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 iliac bone , spreading to its anterior and posterior spines. The bottom contour of the ridge is also 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 the entire length was first noted at the age of 19. By the age of 22, synostosis of the ridge with the ilium is observed in all men, while in women it is observed only at the age of 25 (Table 2). By the time of synostosis of the ridge with the ilium, its formation ends.

Ischium by the time of birth on the 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 indistinctly expressed until the end of the year. At the age of 2, the ischium is already represented by both developed branches.

Table 1

The term of appearance of the accessory nuclei of ossification of the ilium, ischium and pubic bones

Age (in years)	Number of investigated		The presence of ossification nuclei
	Number of investigated		iliac crest		ischial apophysis		apophysis of the lower branch of the pubic bone
	m.	f.	m.	f.	m.	f.	m.	f.
			-		-	-	-	-

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

1 - nuclei of ossification of the iliac crest; 2 - the apophysis of the ischial bone; 3 - accessory nucleus of ossification of the anterior lower 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 to 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, the ischium reaches 10-15 mm, its apex has indistinct contours and is rounded. By the age of 13-17, the top. the bones are already clearly contoured; in about half of those examined, it appears to be flat, as if cut off, in the other half it is rounded.

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

table 2

Duration of synostosis of the iliac crest

Age (in years)	Number of studies	Lack of synostosis	Incomplete synostosis	Complete synostosis
Age (in years)

Rice. 3. X-ray of the symphysis area of a 19-year-old boy.
1 - ischial apophysis; 2 - the apophysis of the lower branch of the pubic bone.

Table 3

The term of synostosis of the ischial apophysis

Age (in years)	Number of studies	Lack of synostosis	Incomplete synostosis	Complete synostosis
Age (in years)

Rice. 4. Radiograph of the anatomical preparation of the pubic bones of 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 the age of 19-22, in women - by the age of 21-25.

Pubic bone by the time of birth on the X-ray diffraction patterns of all investigated persons it is 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. In the 3rd year, an unevenness of the contours is revealed, which by the age of 4-6 takes the form of a "saw" or waviness and histologically represents a zone of calcification of cartilage with its uneven resorption and replacement by bone tissue; here is the growth of the upper branch of the pubic bone in length.

Table 4

Waviness of the contours is more distinctly revealed at the age of 13-16, during the most rapid growth of the bone (Fig. 4); it disappears in girls at the 13-15th year of life, in boys - at the 15-18th year. With the disappearance of waviness, the growth of the superior branch of the pubic bone stops. The anterior tubercle of the obturator foramen is formed due to the primary ossification nucleus of the superior branch of the pubic bone. Radiographically, the tubercle first begins to be detected at the age of 7-9 years. From 13-16 years old, it is visible in about 25% of those examined. The accessory nucleus of ossification of the lower branch apophysis appears at the age of 19-22 (see Table 1). In the first 1-2 years after the 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 enlightenment limited to the ilium, ischium and pubic bones (see Fig. 1). The contours of these bones in the acetabulum area up to 6-7 months of life are smooth. From 8-9 months, a slight unevenness of the upper contour of the cavity is noted, and from 3 years of age - the unevenness of the acetabulum in the region of the anterior and posterior contours, which takes the form of waviness by 4-6 years (Fig. 5, 3). Histological studies by G.P. Nazarishvili and ours showed that the irregularity of the contours of the cavity is due to the uneven growth of bone substance due to the articular cartilage. The waviness of the contours is most pronounced during puberty, when the most intense growth of the pelvic bones is noted. With the onset of synostosis of the bones that form 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-unevenness of the contours of the acetabulum; 4 - "figure of a tear"; 5 - "figure of a crescent".

7- 8-month-olds have over top outline of the acetabulum, in the region of its roof, there is a compaction of the bone substance with very delicate short transversely located bone trabeculae. In most of the children under study, 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 it reaches 1 cm. By the age of 18-19, the thickness of the acetabular roof is 4-6 cm, regardless of gender.

The compact bone substance of the acetabular fossa first begins to appear on radiographs in children at the age of 2 years in the form of a delicate spherical shadow. At the same time, a compact bone substance begins to come to light. medial surface the body of the ischium in the form of a straight vertical strip. Both strips described run almost parallel to each other. At the age of 3, a third short, smoothly rounded strip of compact bone substance of the lower edge of the notch of the acetabulum appears, closing the lower ends of the two strips described above. From the moment of their fusion, an X-ray formation of the acetabulum is created in the form of a "teardrop figure" (A. Kohler, V.S. Maikova-Stroganov). From 4-5 years of age, the "figure of a tear" is observed in all 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 emerge in the form of a gentle, smoothly rounded short shadow with a bulge facing outwards. At the age of 3, the "crescent figure" is observed in half of the subjects, and from 5-6 years - 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 "bones of the acetabulum", located between the ilium and pubic bones, begin to appear for the first time. The shape of the bones is irregular, elongated, 2-4 mm wide and 10-12 mm long. More often one or two such bones are visible symmetrically on both sides, less often on one side. At 10-12 years of age, the "bones of the acetabulum" 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 end of the synostosis of the bones that form the acetabulum, the “bones of the acetabulum” are not revealed.

At the age of 12-13, the third additional bone formation- "epiphysis of the acetabulum". By the time of synostosis of the bones that form the acetabulum, this bone is observed in most of the examined patients (Fig. 6).

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

conclusions

The pubic bone has an apophysis of the lower branch, an additional ossification nucleus of which appears at 19-22 years of age, regardless of gender. Synostosis of the apophysis with the lower branch in men occurs at 22-23 years old, in women - at 22-25 years old.
Additional nuclei of ossification of the iliac crest and the apophysis of the ischium in girls appear at 13-15 years old, in boys - at 15-18 years old. Synostosis of these apophyses, according to our observations, in men occurs at 19-22 years old, in women - at 19-25 years old. However, this issue can be finally resolved only on the condition of studying significantly more observations of persons aged 22-25 years.
Synostosis of the lower branches of the ischial 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 nucleus of ossification of the anterior lower iliac spine appears at 12-14 years of age, regardless of gender. Her synostosis with the ilium in girls occurs at the age of 14-16 years, in a young man - at 15-18 years.
Synostosis of the bones that form 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 body. It supports the spine, allows the trunk and lower limbs to move in a coordinated manner. With the help of it, a uniform redistribution of all load vectors occurs. A twisted pelvis provokes deformation spinal column... This phenomenon has a number of dangerous complications.

Causes of pelvic displacement in children

Various triggers are capable of provoking a curvature of the pelvis. Among the most common disease factors in children are:

Muscle imbalance. Occurs in the absence of adequate physical activity, with the dominance of a sedentary lifestyle. Such phenomena lead to the fact that a certain muscle group in a child gradually weakens (in lying patients it can completely atrophy), while other ligaments are in constant voltage... The main function of the muscular pelvis is to maintain the musculoskeletal system in the normal anatomical position. If one group of ligaments is relaxed and does not work, and the other is tense and is constantly in good shape, the pelvis shifts.
Bone trauma. Children are very mobile. During games, they often fall. Bone fractures, accompanied by a rupture of the pelvic ring, heal for a long time. If the child was provided with an unskilled health care, the fracture does not heal correctly, and this often leads to a disruption in the shape of the joint and to further curvature of the pelvis.
Muscle tears. Damage to any ligament leads to the formation of tension and displacement relative to each other of healthy tissues. The immobility of the joints is disturbed. If the ligaments are not restored, the bones of the pelvis must shift over time. This pathology can develop in different ways. If the muscular lower back is damaged, the pelvis is pushed forward. Rupture of the quadriceps muscle leads to flexion of the hip. Injury of the adductor muscles tilts the most big bone v human body forward and turns the hip 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 weight on one shoulder. 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 uppermost points is increased. In this case, the sacrum is shortened, flattened and rotated around the horizontal axis. In especially severe cases it is possible to change the position of all bones of the largest joint. This can lead to misaligned deformations.
Complications after past diseases... Dysplasia missed in childhood leads to a difference in length lower limbs... Most often, with such a pathology, there is an asymmetry of the pelvis, which forms a skew from right to left or from front to back (back to front). In such a situation, twisting of the main support node often occurs. A flat pelvis is a consequence of previous rickets or poliomyelitis.
Surgical operations. Any surgical interventions in the area of the pelvic bones can be complicated by the 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

There are no characteristic manifestations of pathology. An experienced doctor can recognize it by a set of indirect signs:

pain that occurs only while walking or running;
any discomfort in the lumbar region, thigh, 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 are formed on the feet, they are more pronounced on the side of the skew;
sleep is possible only while lying on your stomach or on your side;
the line of the nose is slanted - one nostril is higher than the other;
the navel is shifted;
dysfunction of the bladder;
bowel 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, based on the patient's complaints, collects an anamnesis, then palpates the painful areas. After analyzing the first data, an instrumental examination is assigned:

X-ray of the spine and pelvic bones;
CT or MRI of the painful area.

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

Therapies

It is impossible to treat the symptoms of pathology without eliminating the cause of the ailment. If it is possible to do without surgery, the patient is assigned:

manual therapy;
massotherapy;
physiotherapy.

Manual therapy in children is carried out without sudden stretching. The massage starts with thoracic spine, then gradually the specialist descends to the lower back. Uses motions to help you shoot muscle spasm, eliminate the existing cartilaginous infringement. The vector of efforts is constantly changing. If necessary, the doctor can use force to reduce the affected segment.

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

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

Feet shoulder-width apart, feet pressed into the floor, stand on our toes and raise one hip. Then to the starting position.
Hands on the waist, shake the hips to the right and left, twist them in a circle, trying to draw an eight with them.
Feet shoulder-width apart, feet firmly pressed to the floor, we make a torso tilt and try to reach the toes with our fingers. If it doesn't work right away, we swing the body and try to increase the tilt amplitude until we can reach the goal. In this case, be sure to make sure that the pelvis does not tilt back. Then we take the starting position and bend back. We repeat ten times.
We move our legs to 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 restrict movement, so the deflection is constrained.
The same starting position, we put our hands on the hips, tilt the body together with the pelvis to the side, with our hands we make an effort in the opposite direction.
We stand up straight, hands behind the head, palms close together, open our elbows to the sides, squat, but not completely, 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, with great care. If there is pain in the pelvis, you should immediately stop gymnastics and inform your doctor about it. In the absence of discomfort, experts recommend gradually increasing the load and bringing the performance of each type up to twenty times.

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

In the presence of a pronounced syndrome, the patient is recommended to take analgesics and apply to the painful area medicinal ointments... Symptoms inflammatory process are stopped by non-steroidal anti-inflammatory drugs. Therapeutic activities must be appropriate for the child's age.

Possible complications and consequences

Any displacement of the pelvis, even the smallest, can provoke a curvature of the spine and impairment of its function. The described phenomenon leads to a change in the axis and to an incorrect distribution of the load within the column. As a result, excessive pressure is formed at certain points. In these places, a gradual destruction of bones occurs, intervertebral hernia, deforming osteoarthritis, stenosis of the spinal canal, radiculitis develops. Diseases of the spine contribute to the appearance of pain in the back, in the shoulders, in the neck.

Some patients develop carpal tunnel syndrome. The oblique pelvis causes a shift in the center of gravity. In this case, the bulk of the load begins to act on one leg. From this comes lameness.

Preventive measures

To prevent deformation and relieve the already existing symptoms of pelvic tilt, experts recommend:

swim more;
go in for equestrian sports;
train the muscles that hold the spinal column;
strengthen the pelvic floor ligaments;
to live an active lifestyle;
do exercises in the morning.

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

Forecast

The 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, on the dysfunctions that it could provoke. Achieve positive results hard. During the existence of the problem, a person develops an incorrect stereotype of movements: muscles interfere with recovery, creating, in contrast to the skewed pelvis, a block of ligamentous groups trying to eliminate this displacement by reflex tension. Only correctly selected treatment and strict adherence to the recommendations of doctors can count on favorable prognosis.

Fractures of the pelvic bones occur most often at the age of 8 to 12 years - when the ligamentous apparatus is not yet sufficiently developed, there are elastic cartilaginous layers, and the muscles are already strong. Fractures of the pelvic bones are always easier in children than in adults. So, if in car accident in an adult, the ilium breaks vertically on both sides, then in a child the ilio-sacral joint breaks on one side. Subperiosteal fractures are easiest when the periosteum remains intact, and only the cortical layer is torn. Traumatologists compare this condition with a green branch or a 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, performing a split, pushing off when jumping or strong blow on the ball. One or more signs are noted:

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

First aid

If there is even one symptom, a doctor should be consulted immediately.

Important: before the ambulance arrives, lay the child on a shield or any hard surface to prevent further displacement of the fragments. You can place a small roll of clothes or towels under your knees. Cover with a couple of blankets in cold weather. Do not fuss and do not panic, you cannot do anything on your own. Do not try to stand or plant.

Classification of pelvic fractures

Fracture in children is diagnosed after full examination, X-ray examination is performed urgently in the emergency room. If the doctor is not clear about everything, 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 next fractures pelvic bones:

The marginal individual bones are when the attached muscle tears off the marginal portion. The entire pelvic ring remains intact;
Rupture of the pelvic ring - anterior or posterior:
Anterior - pubic or ischial bones, womb rupture. Sometimes these injuries are combined;
Posterior - iliac or sacral bones or their joints, as well as double fractures;
Acetabulum;
Fracture associated with dislocation.

Modern diagnostic equipment allows you to establish the exact location and nature of fractures immediately after their appearance. If the pelvic ring remains intact, then 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. The spongy substance in a fracture in children is destroyed more strongly than the compact one. The fracture line is located at the junction of the bone with cartilage and is poorly visible on an x-ray.

What Happens During Various Fractures?

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

The lightest pelvic fractures - marginal - are straight or avulsion fracture ischial or pubic bone. With well-developed muscles, the fragment can be displaced 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 disturbs posture and gait, and in girls - developing birth canal, which makes spontaneous childbirth impossible in the future.

These fractures require the utmost attention and careful reduction or comparison of the fragments. Injuries are single and multiple, when the bones are torn into fragments like a butterfly. The most difficult case is a double fracture of the pelvis in children, when the front and rear part rings. The inner part of the pubic bone is shifted downward, and the outer part is shifted upward. This condition is named after Malgen, the physician who first described the mechanism of displacement.

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

Fracture dislocation is most often found in 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 fast fusion... At the ends of tubular and flat bones in children, there are growth zones, elastic growth cartilage. All this softens and absorbs the force of the impact. In children organic matter more than mineral, so bones are flexible and can withstand significant loads. The peculiarities of the organism are the basis for the fact that fractures of the pelvic bones in children heal 3-4 times faster than in adults.

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

Conservative - immobilization plaster cast or skeletal traction;
Operational.

Conservatively treated marginal fractures pelvic bones in children, as well as those cases when the pelvic ring remains intact. Sometimes even a detached fragment that has been removed at a considerable distance can be returned to its place by skeletal traction - this is decided individually, the age and strength of the muscles matters. Dislocations are also treated without surgery.

Surgical treatment is always necessary when the geometry of the pelvic ring is violated. The best results are obtained by metal osteosynthesis or the connection of bone fragments with metal plates. The operation is also necessary in the case when the bone is crushed, the blood supply of small fragments is impaired. Such fragments must be removed.

Rehabilitation

Sex differences in bone pelvis are already outlined in a newborn child, the formed pelvis of which 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 entrance. The pubic arch of a newborn girl is also somewhat wider than that of a boy.

V general research pelvis in newborns showed completely different ratios in the size and shape of the pelvis in different sexes. In addition to the degree of ossification, the pelvis of a newborn is very different from that of an adult. The sacrum, with its relatively narrow wings, has here 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 slightly protrudes in the form of a promontory. The anterior surface of the sacrum, both horizontally and vertically, is devoid of concavity. The tailbone is curved slightly forward. Curvature of the spinal column in the lumbar and chest areas consistent with the lack of sacrum curvature is insignificant. The almost vertical iliac bones 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 primarily influenced by the pressure exerted by the spinal column when sitting, standing and walking, the counterpressure from the lower extremities connected with the pelvic ring in hip joints, as well as the pressure exerted from the iliac bones on the pubic articulation.

Physiological kyphosis of the thoracic part of the spine results in a compensatory curvature of the lumbar part of it (lumbar lordosis) and, in addition, causes the sacrum to rotate around its horizontal axis, and the cape under pressure from the side of the body moves down and forward. The apex of the sacrum, held in its lower parts by strong cords of the spinous-sacral and tuberosacral ligaments, cannot move back, which is why the entire sacrum must bend around its horizontal axis and due to this becomes concave in front. In this case, the sacral vertebrae are most strongly compressed behind and are lower here than in the front.

If there is no burden from the side of the spinal column, for example, with prolonged lying on the back, 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 of the pelvis in the transverse direction (recumbent pelvis). If, further, there is no back pressure from the thighs with the existing pressure from the spinal column, then the opportunity for the pelvis to expand laterally becomes disproportionately large. In the absence of a strong connection between the pelvic bones in the symphysis (split pelvis), the pelvic ring should gap wide in front.

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

So, characteristic changes the pelvis of a newborn consists in rotation and flexion of the sacrum, an increase in the transverse and straight sizes pelvis.

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

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

The skull at the time of birth is represented by a large number of bones connected by wide cartilaginous and connective tissue layers. The seams between the bones of the fornix (arrow-shaped, coronal, occipital) are not formed and begin to close only from the 3rd-4th month of life. The edges of the bones are even, the teeth are formed only in the 3rd year of the child's life. The formation of sutures between the bones of the skull ends by 3-5 years of age. The overgrowth of seams begins after 20-30 years.

The fontanelles of the skull of a newborn

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

The small fontanelle is located between the occipital and parietal bones; by the time of birth, it is closed in 3/4 of healthy full-term babies, and in the rest it closes by the end of 1–2 months of life.

Lateral fontanelles (anterior wedge-shaped and posterior mastoid) in term infants are closed at birth.

The structure of the skull of a newborn

Brain department The volume of the skull is significantly larger than the facial one (in a newborn, 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 up to 7 years. In the first year of life, there is a rapid and uniform increase in the size of the skull, the thickness of the bones increases by 3 times, the structure of the bones of the cranial vault is formed. At the age of 1 to 3 years, ossification points merge, cartilage tissue gradually replaced by bone. On the 12th year, halves grow together lower jaw, on the 2nd - 3rd year in connection with the strengthening of the function of the masticatory muscles and the completion of the eruption of milk teeth, the growth of the facial skull increases. From 3 to 7 years old, the base of the skull grows most actively, and by the age of 7 years, its growth in length basically ends. At the age of 7-13, 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, mainly the facial part of the skull grows, sex differences appear. Thickening and pneumatization of the bones occurs, which leads to a decrease in their mass.

Spine of an infant

The length of the spinal column in a newborn is 40% of its body length and doubles in the first 2 years of life. However, different parts of the spinal column grow unevenly, so, in the first year of life, it grows most rapidly lumbar, the slowest is the coccygeal.

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

The spine of a newborn has the appearance of a gentle arc, concave in front. Physiological curves begin to form only from 3-4 months. Cervical lordosis develops after the child begins to hold his head. 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, sacral kyphosis is formed compensatory. The bends 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 the age of 7, and lumbar lordosis- by the period of puberty. Thanks to the bends, the elasticity of the spinal column increases, shocks and concussions when walking, jumping, etc. are softened.

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

Baby chest

The chest of a newborn has a conical shape, its anteroposterior size is larger than the transverse one. The ribs extend from the spine almost at right angles and are located horizontally. The rib cage is, as it were, in the position of maximum inspiration.

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

When the baby begins to walk, the sternum drops and the ribs gradually take on an inclined position. By the age of 3, anteroposterior and transverse dimensions rib cages are compared in size, the angle of inclination of the ribs increases, costal breathing becomes effective.

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

Pelvic bones in a child

The pelvic bones in 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... The change in the shape and size of the pelvis occurs under the influence of body weight, 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: in boys, the pelvis is taller and narrower than in girls.

Up to 12-14 years old, 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 shallower than in an adult, as a result of which most of the femoral head is located outside of it. The articular capsule is thin, the ischio-femoral ligament is not formed. Gradually with growth pelvic bone in thickness and formation of the edge of the acetabulum, the head of the femur is immersed deeper into the joint cavity.

Limbs in children

In newborns, the limbs are relatively short. 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 1215 years, in girls at the age of 13-14 years.

In a newborn and a child of the first year of life, the foot is flat. The line of the transverse joint of the tarsus is almost straight (S-shaped in an adult). 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.

Teeth in children

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 milk teeth is as follows: 2 internal lower and 2 internal upper incisors, and then 2 external upper and 2 external lower incisors (by the year - 8 incisors), at the age of 12-15 months - the anterior molars (molars), at 18-20 canines, at 22-24 months - posterior molars. Thus, by the age of 2, a child has 20 milk teeth. For an approximate determination of the proper number of milk teeth, you can use the following formula:

where: X is the number of milk teeth; n is the child's age in months.

Replacement of milk teeth with permanent ones

The period of replacing milk teeth with permanent ones is called the period of a changeable bite. Permanent tooth usually erupts 3-4 months after milk loss. The formation of both milk and permanent bite in children is a criterion for the biological maturation of a child (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 milk teeth (as preparation for the eruption of permanent, wider teeth) and their wear.

The change of milk teeth to permanent ones begins at the age of 5. Teething order permanent teeth usually the following: at 5 - 7 years old the first molars (large molars) erupt, at 7 - 8 years old - internal incisors, at 8 - 9 years old - external incisors, at 10 - 11 years old - anterior premolars, at 11 - 12 years old - posterior premolars and canines, at 10 - 14 years old second molars, at 18 - 25 years old - wisdom teeth (may be absent). For a rough estimate of 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 disturbances, diarrhea, etc. The formation of both milk and permanent bite in children - important indicator biological maturation of the child. A permanent bite should normally be orthognathic or straight.