Features of the development of the skeletal system in children. Anatomical and physiological features of the skeletal system
In newborns, the pelvis has a funnel shape. The wings of the iliac bones are located more vertically, their ridges are cartilaginous (weakly, S-shaped curved). The small pelvis is underdeveloped, the entrance to it is narrow, longitudinally oval in shape. The promontory is weakly expressed and formed by the I and II sacral vertebrae. Each innominate bone consists of three parts: the ossification nuclei of the iliac, ischial and pubic bones, connected to each other by a layer of cartilage.
The coccyx consists of 4-5 cartilaginous vertebrae. In the thickness of the I-III sacral vertebrae there are five ossification nuclei. During early childhood, the ossification nuclei of the sacrum significantly increase in size, and in the preschool period they begin to merge with each other, forming individual vertebrae (segments) of the sacrum. In parallel with the growth of individual bones, the structure of the pelvis changes, and the position of the pelvis changes. In the preschool period, the first sacral vertebra shifts in the ventral direction, and the P-III in the dorsal direction. As a result, the sacrum acquires kyphosis, and a promontory is formed between the V lumbar and I sacral vertebrae.
At the same time, the position of the iliac bones changes, the bodies of which undergo rotation around the sagittal axis. As a result, their wings begin to diverge to the sides and the pelvis loses its funnel-shaped shape. The line of entry into the small pelvis becomes clearly defined. The size of the entrance to the small pelvis changes. During puberty, the pelvis acquires features characteristic of the adult pelvis. The pelvic cavity takes on a cylindrical shape in girls. The pelvic surface of the sacrum loses its fragmented structure.
In newborns, the muscle that lifts the anus into its main parts is not differentiated and is a thin (0.8-1 mm) muscular plate. During early childhood and preschool age, the muscle thickens and differentiates into two parts: m rubococygeus and m iliococygeus, turning into one another.
The rectum in newborns is relatively long (50-60 mm), its sections are poorly differentiated. The pelvic region is short, stretched and completely occupies the pelvic cavity. The ampullary section is usually absent. The anal section has a significant length (30-40 mm), its narrowed diameter in the perineal part does not exceed 15 mm (V. Frolovsky). At the site of the transition of the pelvic to the anal region there is a pronounced transverse fold of the mucous membrane - plica transversalis interior. The level of location corresponds to the bottom of the rectovesical or rectouterine recess and is projected onto the first coccygeal vertebra. The wall of the rectum is not fully formed, its muscular wall is poorly developed. The mucous membrane is not sufficiently fixed, which can lead to its loss. Throughout the anal part, the mucous membrane forms high longitudinal folds (columna anales), between which lie the deep sinus analis. The hemorrhoidal zone is individually different; in some newborns it is well defined, in other cases it is only outlined in the form of a narrow strip.
As the child grows, the structure of the rectum and its topography change. In the first year of a child’s life, its diameter increases significantly, while the intestine shortens (up to 37-47 mm). In the second half of infancy, a sacral bend appears in the intestine, and in early childhood it becomes clearly pronounced.
In children 1-3 years old, the transitional form of the rectum is much more common, and in the preschool years the ampullary form of rectum is observed (L.V. Loginova-Katricheva).
- Surgical anatomy of congenital defects, pelvic and perineal organs.
- Bladder exstrophy and diverticulum are developmental abnormalities of the bladder.
- Exstrophy of the bladder occurs as a result of a violation of embryogenesis, due to a violation of the development of the genital tubercle and especially the anterior abdominal wall, a severe defect develops, accompanied by the absence of the anterior wall of the bladder and the corresponding part of the anterior abdominal wall. In the lower abdomen of such children, the mucous membrane of the posterior wall of the bladder with hypertrophied folds is visible, its edges are fused to the skin of the anterior abdominal wall. In the lower parts of the protrusion, the openings of the ureters are visible. With age, it scars and becomes covered with papillomatous growths. The defect is characterized by divergence of the pubic bones, congenital inguinal hernia, cryptorchidism; in girls - cleft clitoris, etc.
The cause of diverticula is explained by the presence of “weak” spots in the walls of the bladder, or incomplete reverse development of the urachus.
B. D. Ivanova, A.V. Kolsanov, S.S. Chaplygin, P.P. Yunusov, A.A. Dubinin, I.A. Bardovsky, S. N. Larionova
After birth, the child continues to grow and differentiate bones and form the skeleton. In the body, the functions of bone tissue are diverse: firstly, it is the support and protection of internal organs, bone marrow; secondly, bones, in fact, are a reservoir of inorganic (calcium, phosphorus, magnesium) and some organic substances; thirdly, bone tissue in extreme conditions is a protection against acidosis, after the exhaustion of the functions of the kidneys and lungs; fourthly, it is a “trap for foreign substances” (heavy, radioactive, etc.).
The architecture of bone tissue can be divided into two types: trabecular and cancellous. Trabecular bone in its structure resembles the lattice structure surrounding the vessels. Osteophytes in it are scattered throughout the structure. In the fetus and embryo, almost all skeletal bones have a trabecular structure. After birth, such a structure is preserved in the vertebrae, flat bones, and also in long bones, being a temporary structure during the formation of lamellar bone.
Dense bone is the final structure found in the adult human skeleton. It consists of a system of Haversian canals and is built of a hard calcified matrix. Osteophytes in it are arranged in an orderly manner and oriented along the vascular canals. The development of dense bone is gradual as physical activity increases.
The main cellular elements of bone tissue are osteocyte, osteoblast and osteoclast. Osteogenesis in humans is unique and different from all representatives of the animal world. The final bone structure is formed after birth, which is associated with the onset of steady walking.
By the time a child is born, the diaphyses and epiphyses of the tubular bones are already represented by bone tissue. All spongy bones (hands, feet, skull) are made of cartilage tissue. At birth, ossification nuclei form in these bones, giving rise to dense bone growth. Based on the ossification points, one can judge the biological age of the child. The growth of tubular bones occurs due to the growth of cartilage tissue. Elongation of bones occurs due to the growth of cartilage tissue in length. The growth of the bone in width occurs due to the periosteum. At the same time, from the side of the medullary canal, the cortical layer of the periosteum is subject to constant resorption, as a result of which, as the bone grows in diameter, the volume of the medullary canal increases.
After birth, the bone is rebuilt many times in its development - from a coarse fibrous structure to structural bone.
With age, the process of osteogenesis occurs - remodeling of bone tissue. Bone density increases gradually. The content of the main mineral component of bone tissue - hydroxyapatite - increases with age in children.
In general, there are three stages in the process of bone formation:
1) formation of the protein basis of bone tissue; it mainly occurs in utero;
2) the formation of crystallization centers (hydroxyapatite) with subsequent mineralization (osteosynthesis); it is characteristic of the postpartum period;
3) osteogenesis, when the process of bone remodeling and self-renewal occurs.
At all stages of osteogenesis, vitamin D and the normal presence of Ca, Mg, and P ions in food are necessary. An indispensable condition for the proper formation of the skeletal system is exposure to air and external insolation.
If any of these components is deficient, the child develops rickets, characterized by changes in the skeletal and muscular systems and disorders of the central nervous system.
In children, unlike adults, the younger they are, the more abundantly the bones are supplied with blood. The blood supply to the metaphyses and epiphyses is especially developed. By the age of 2, a unified intraosseous circulatory system is formed, the network of epimetaphyseal vessels and growth cartilage are well developed. After 2 years, the number of bone vessels decreases significantly and increases again by puberty.
The periosteum in children is thicker than in adults. Due to this, the bone grows in thickness. Bone marrow cavities form with age. By the age of 12, a child’s bone already resembles that of an adult.
In the development of bones in children, periods can be distinguished when the bones are especially sensitive to harmful factors.
1. Breast period, early or pre-school period, the first 3 years of life, when bone growth and calcification, saturation and deposition of minerals (calcium, phosphorus) occur. Various osteopathies occur easily - rickets, rickets-like conditions. Therefore, rational feeding of the child and compliance with his daily routine are of particular importance.
2. School and adolescence periods, when differentiation and accumulation of bone mass is completed. Borderline osteochondropathy is observed in children. Risk factors for impaired bone formation in children are nutritional disorders and inadequate physical activity.
Scull
The skull of a newborn consists of many bones. Sutures such as sagittal, coronal, and occipital are open. Their closure begins by 3-4 months of age. In full-term babies, the lateral fontanelles are closed at birth. The posterior, or small, fontanelle, located at the level of the occipital and parietal bones, is open in 25% of newborns. It closes by 4-8 weeks of the baby's life. The large fontanel is located at the junction of the parietal and frontal bones, or the coronoid and sagittal sutures. It is always open, and its size in a newborn ranges from 3x3 cm to 1.5x2 cm. Normally, the large fontanel closes by 10-18 months.
The shape of the head in children can be different, but more often it is round and symmetrical. The facial skull develops with age.
Spine
The human spine is a unique bone formation that promotes upright posture, which is formed parallel to the growth of the child. Gradually, with age, the spine acquires its own curves, which take on the movement of the center of gravity of a walking or standing person.
The first curves of the spine appear from the beginning of holding the head and shoulder girdle, and by 2-4 months the anterior curve of the cervical spine is formed. After developing the ability to stand upright and walk, an anterior bend in the lumbar spine and almost simultaneously a thoracic curve of the spine are formed. The uneven growth of individual segments of the body, spine, head and limbs leads to the fact that the center of gravity of the body moves significantly as children grow. So, if in a newborn in an upright position the center of gravity is at the level of the processus xyphoideus, then in an older child it moves down, but does not reach the level of the navel. At the age of 5-6 years, the center of gravity is already below the navel, and by 13 years - below the level of the iliac crests.
In children, unlike adults, the fixation of the spine is unstable, imperfect, and under the influence of external factors (wrong posture), persistent deformations of the bones of the spine (scoliosis and abnormal posture) can occur.
Rib cage
The smaller the child, the relatively wider and shorter the chest, while the ribs are horizontal. The chest of a child is more rounded than that of an adult. Its transverse size in a newborn is 25% larger than the mid-lengthwise one, their chest is in a state of as if inhalation. In the future, the chest grows in length, while the ribs descend, forming an obtuse angle with the spine, and its anterior diameter grows intensively. At 3 years old, effective costal breathing is formed. By the age of 12, the chest enters a state of maximum inspiration, and by the age of 15, the final increase in its transverse diameter is completed.
The pelvic bones in young children resemble a funnel. The formation of sexual differences in the pelvis begins at puberty.
Methods for studying the skeletal system and joints
Data on the anamnesis of diseases of the skeletal system are usually collected from the words of parents, next of kin or persons involved in the upbringing of the child. Older children can significantly add to the history of the disease themselves. When questioning, pay attention to the timing of the appearance of certain changes. Firstly, the presence of pain (arthralgia, myalgia, osalgia) is detected, secondly, changes in the configuration of bones and joints, and thirdly, the state of mobility in the joints. When complaining of pain, their localization, symmetry, nature and intensity, duration, frequency are noted. Then they ask about the factors that contribute to the increase or disappearance of pain (warmth, rest, drugs). The next moment is the establishment of mobility disorders (morning stiffness, limitation of movements due to pain, etc.). After that, they ask about the connection between the onset and appearance of pain or changes in the joints, bones with any disease (previous infections, injuries).
Inspection is carried out from top to bottom (head, trunk, limbs), while good lighting is important. In young children, attention is paid to pathological changes in the shape of the head, which are especially often observed in rickets. The bones of the skull can be oblique, asymmetrical, the frontal, parietal and occipital tubercles increase. Often the occipital bone becomes denser and smoother.
With congenital syphilis, pathological fragility of the skull bones may develop. In newborn children, deformation of the skull associated with birth trauma is manifested by a tiled arrangement of bones (located on top of each other), their depression or protrusion, often followed by subperiosteal hemorrhages (cephalohematomas). Brain hernias may also be observed.
The head is measured to assess physical development or to identify pathology (micro- and macrocephaly).
Microcephaly develops in utero or with early closure of sutures (against the background of vitamin D hypervitaminosis). A large head with macrocephaly as a pathological condition most often develops when there is a violation of hemocerebrospinal fluid dynamics - hydrocephalus. At the same time, the fontanelles and even the seams are always open.
When examining, pay attention to the age-related proportionality of the development of the facial and cerebral skull.
Then the chest is examined. Pay attention to its shape, symmetry, uniformity of participation in the act of breathing, various deformations (“chicken breast”, funnel chest, peripneumonic fissure of Filatov-Garrison, cardiac hump, etc.), indicating a congenital or acquired defect.
Assess the child's posture in a standing position: heels together, arms at sides. With postural disorders, there are lateral curvatures of the spine - scoliosis, lag of the shoulder blades from the chest, stoop, pathological lordosis (increased forward bending of the spine) and kyphosis (increased backward bending of the spine). Sideways curvature of the spine is especially common - scoliosis (this is always a pathology). Suspicion of scoliosis must be confirmed x-ray.
It is necessary to examine the pain of the vertebrae when palpating and moving, especially if the child complains of pain in the spine.
The upper limbs are examined to determine their length and the presence of deformity. There are standards for the development of limbs in children of different ages. Long-armedness is more often detected in diseases of the connective tissue (Marfan's disease). Shortening of the limbs is associated with Down's disease and chondrodystrophy. The fingers are also examined to identify the symptom of “drumsticks”, osteopathies, arthritis and other changes.
When examining the lower extremities of a newborn, pay attention to the symmetry of the gluteal folds, the number of folds on the inner surface of the thighs (with congenital dislocation of the hip joint, there are more folds), shortening of the limbs, X- or O-shaped curvature of the legs (with rickets). Often, older children are diagnosed with flat feet, which is a pathological condition. To determine it, plantography is carried out - they study the footprint on a sheet of paper.
The following standard sequence helps in quick screening of the skeletal system and its recording:
1. Front view, arms extended along the body. At the same time, the shape of the legs, the position of the head, the symmetry of the shoulders, triangles of the waist are determined, the deformity of the chest, the symmetry of the hips are excluded.
2. Side inspection. Determine the shape of the chest, abdomen, protrusion of the shoulder blades, the shape of the back.
3. Inspection from the back. The symmetry of the angles of the shoulder blades, the shape of the spine, the shape of the legs, the axis of the heels are revealed.
4. At the end of the examination, the child is offered to walk around the office to identify gait disorders.
Based on the results of the inspection, testing is carried out: 1) without deviations - negative values for all items; 2) minor deviations requiring the supervision of a pediatrician - with positive answers to questions 3-7; 3) significant deviations requiring additional examination and treatment by an orthopedist or vertebrologist - positive answers to 5 questions (1, 2, 8, 9, 10).
Palpation of bones is a medical procedure. It is aimed at detecting softening of the bones, the condition of the fontanelles or the sutures of the skull in newborns and infants. They also palpate the ribs, bones of the limbs, examine the joints, and on the basis of changes in their shape, size and range of motion, one or another pathology is judged. If necessary, an X-ray examination is prescribed. It is carried out with suspicion of inflammatory-dystrophic changes in bones, joints; in bone tumors, to determine bone (biological) age, in the diagnosis of diseases accompanied by osteoporosis, bone softening. Laboratory methods are also used to diagnose diseases of the skeletal system: they determine the level of Ca, P, alkaline phosphatase in the blood and urine.
Teeth
In children, the first teeth are the baby teeth. They erupt in a certain sequence.
The formation of the occlusion of baby teeth is of great importance. It is formed by 2.5-3.5 years and is characterized by the following positions:
1) small spaces between teeth;
2) absence of tooth wear;
3) the distal surfaces of the upper and lower dental incisors are located in the same frontal plane;
4) orthognathic bite, when the upper incisors slightly cover the lower incisors.
The next period of tooth development begins at the age of 3.5 - 6 years. At this time, interdental gaps (diastemas) appear - between the incisors or trema - between other teeth. The teeth are already being erased, the lower and upper ones do not match. Orthognastic bite turns into a straight one. The primary occlusion of teeth is of great importance for the formation of the ability to chew food and the development of speech.
The period of mixed dentition begins with the appearance of permanent teeth, while milk teeth are also preserved. The first permanent teeth erupt at the age of 5 - these are the first molars. Then the milk teeth gradually fall out and the permanent teeth appear. By the age of 11, the second molars erupt. Third molars (wisdom teeth) appear between the ages of 17 and 20, and sometimes even later. To estimate the number of permanent teeth, the following formula is used:
X \u003d 4n - 20, where n is the child's age, years.
Children of any age often experience dental disease - caries, in which gradual destruction of the tooth structure occurs. Therefore, in the upbringing of a child, a special place is occupied by the prevention of caries.
In this regard, rational nutrition and adherence to the principles of feeding a child with breast milk are important. Particular importance is attached to the content of fluoride in food as a means of preventing caries. Children should brush their teeth with prophylactic toothpastes that do not contain fluoride, but it must be contained in food products. In addition to fluorine, the child also needs calcium.
Rational nutrition should also include organic low-digestible carbohydrates. The latter have a positive effect on the growth of normal oral flora. For proper development of teeth and prevention of caries, a diet containing starch, glycogen, disaccharides, and glucose is necessary. It is important to teach your child to chew food properly. After eating, be sure to rinse your mouth and brush your teeth with toothpaste at least twice a day - in the evening and in the morning.
The pelvic girdle consists of the pubis, ilium and ischium, which form independently and fuse with age to form the pelvis, connected posteriorly to the sacral spine. The pelvis serves as a support for the internal organs and legs. Thanks to the mobility of the lumbar spine, the pelvis increases the range of motion of the leg.
The leg skeleton consists of the femur (thigh skeleton), the tibia and fibula (tibia skeleton) and the bones of the foot.
The tarsus consists of the talus, calcaneus, navicular, cuboid, and three cuneiform bones. The metatarsus is formed by five metatarsal bones. The toes consist of phalanges: two phalanges in the first toe and three phalanges in the remaining fingers. Sesamoid ossicles are located, as in the hand, but are much better expressed. The largest sesamoid bone in the leg skeleton is the patella, located inside the tendon of the quadriceps femoris muscle. It increases the leverage of this muscle and protects the knee joint at the front.
Development of the pelvic bones
The most intensive growth of the pelvic bones is observed in the first three years of life. In the process of fusion of the pelvic bones, several stages can be distinguished: 5–6 years (beginning of fusion); 7–8 years (pubic and ischial bones fuse); 14–16 years (pelvic bones are almost fused); 20–25 years (end of complete fusion).
These terms must be taken into account during labor movements and physical exercises (especially for girls). When jumping sharply from a great height and when wearing high-heeled shoes, the unfused pelvic bones are displaced, which leads to their improper fusion and narrowing of the outlet from the pelvic cavity, leading to difficulty in childbirth. Malunion can also be caused by excessive improper sitting or standing, or carrying heavy loads, especially when the load is unevenly distributed.
The size of the pelvis in men is smaller than in women. There is an upper (large) pelvis and a lower (small) pelvis. The transverse size of the entrance to the pelvis in girls changes abruptly in several stages: at 8-10 years (increases very quickly); at 10–12 years (there is a slight slowdown in its growth); from 12 to 14–15 years (growth increases again). The anteroposterior size increases more gradually; from the age of 9 it is less than the transverse. In boys, both sizes of the pelvis increase evenly.
Development of the bones of the lower extremities
By the time of birth, the femur consists of cartilage, only the diaphysis is bone. Synostosis in long bones ends at the age of 18 to 24 years. The kneecap acquires the shape characteristic of an adult by the age of 10.
The development of the tarsal bones occurs much earlier than the carpal bones; ossification nuclei in them (in the calcaneus, talus and cuboid bones) appear in the uterine period. In the sphenoid bones, they occur at 1-3-4 years, in the scaphoid - at 4.5 years. At the age of 12-16, the ossification of the calcaneus ends.
The metatarsal bones ossify later than the tarsal bones, at the age of 3–6 years. Ossification of the phalanges of the foot occurs in the third or fourth year of life. Final ossification of the leg bones occurs: femur, tibia and fibula - by 20–24 years; metatarsals - 17–21 in men and 14–19 in women; phalanges - by 15–21 in men and by 13–17 years in women.
From the age of 7, boys' legs grow faster. The highest ratio of leg length to body length is achieved in boys by the age of 15, and in girls by the age of 13.
The human foot forms an arch that rests on the heel bone and the anterior ends of the metatarsals. The general arch of the foot consists of the longitudinal and transverse arches. The formation of the arch of the foot in humans occurred as a result of walking upright.
For the formation of the arch of the foot, the development of the leg muscles, in particular those that hold the longitudinal and transverse arches, is of great importance. The arch allows you to evenly distribute the weight of the body, acts like a spring, softening the shock and shock of the body while walking. It protects the muscles, blood vessels and nerves of the plantar surface from pressure. Smoothing of the arch (flat feet) develops with prolonged standing, carrying heavy loads, and wearing narrow shoes. Flat feet lead to problems with posture and gait mechanics.
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 a car accident an adult’s iliac bones are broken vertically on both sides, then a child’s 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, pushing off while jumping or hitting the ball hard. 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, a doctor should be consulted immediately.
Important: Before the ambulance arrives, place the child on a backboard or any hard surface to prevent further displacement of the fragments. Under the knees, you can put a small roller of clothes or towels. In cold weather, cover with a pair of blankets. Do not fuss and do not panic, you cannot do anything on your own. It is forbidden to try to put on his feet or plant.
Classification of pelvic fractures
The diagnosis of a fracture in children is made after a full examination; an x-ray examination is performed urgently in the emergency room. If everything is not clear to the doctor, a magnetic resonance or computed tomography scan may be prescribed. 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:
In children, the following pelvic fractures are classified:
- 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 mildest pelvic fractures are marginal fractures, which are a direct or avulsion fracture of the 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 emerging 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 front and back of the ring breaks. 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 of the femur fits - 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 strong and very flexible, it contains a large number of blood vessels - this creates the prerequisites 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. Children have more organic substances than mineral substances, so the 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 with a plaster cast or skeletal traction;
- Operational.
Conservative treatment of marginal fractures of the pelvic bones in children, as well as those cases where 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
anonymous, Male, 15 years old
I’ll say right away - I know that according to honey. Everything is normal by standards - but aesthetics have been my dream since childhood. Now I train without skipping, but I need to overcome damn genetics, it’s not for nothing that they say that a person can do anything... The rest of the question, hello. I recently turned 15. Since childhood, I wanted to have broad shoulders and a narrow lower part, but I believed that it would come on its own... At the age of 13, my height was approximately 178. At 13 from 66kg dried up to 59-60. At 14 I went to the gym, intensively trained my upper body, and barely touched my lower body. Weight now - 69 kg. But I have an aesthetic problem - narrow shoulders and a wide pelvis, as well as a narrow chest. I only grew to 181 during this time, from exercises - bench presses, sitting (sometimes standing), I did squats for just a month, I do a lot of pull-ups. Shoulders by bones are approximately 43-45 cm, not exactly, as I measured with a meter, the width of the chest along the ribs in front is approximately 28 cm (!!!), and the girth on exhalation and inhalation is 96/104, respectively. I took hormones, although only once - stg 0.63, Dough - 7 (approximately, I don’t remember). So, how can I influence the growth of my shoulders and how can I slow down the growth of my pelvis? I look terrible in clothes, and my shoulders are the size of 12-13 year olds... Maybe I should take HGH with consultation from an endocrinologist and do breathing exercises (squats, pullovers) and swimming? Or just swim hard? Do heavy loads on top of the shoulders (seated press, for example) harm the height and sloping of the shoulders? What exercises should you do to grow your bone(!!!) core (shoulders, collarbone, or whatever is responsible for the width) and chest? Only you can not assume, but use facts, so there is no faith in anything good left... And is there a possibility that my growth has ended (some say that growth zones can close at 15), since I am growing slowly? And how long are the shoulders? Tell me how to straighten the proportions, and, if you can, answer all the questions, it’s very necessary, it hurts to see how the dream goes further and further.... And, if necessary, tell me which doctor you need to see (surgeon/endocrinologist/therapist and etc.) If necessary, I can attach a photo
A photo will always help, because according to the data, the breast volume is sufficient, I don’t see any disharmony. Whether growth has ended can be checked by taking an x-ray of the growth zones (although there is no point, but radiation yes). If you want to grow up, jump and swim. The doctor only needs to rule out Kleinfelder syndrome (including mosaic), but according to your data, it is extremely unlikely. Now - exercises for the shoulders. Wide grip pull-ups, overhead presses, one-arm presses, chest rows (for the lats). Swimming. For the chest - bench press with a wide grip. Deep squats can actually stimulate some expansion of the pelvis during growth. I think that with the end of puberty the proportions will change, but if you apply great effort, correction is possible in any case. Muscles grow under 3 conditions - hormones, training, nutrition. If there are not enough hormones yet, then intensive training will not bring an effect now, but there will be a delayed effect. Training for muscle growth - with heavy weights, necessarily squats and deadlifts, which I don’t recommend now. Up to 17 years old - emphasis on swimming. It has not been officially confirmed that training with heavy weights inhibits growth, but just in case, most trainers recommend that amateur athletes wait to lift heavy weights until growth is completed, and I do too. Good luck!
anonymously
Unfortunately, now there is only a photo from the back, there are problems with the phone. By medical standards, I repeat, it’s normal, but for aesthetics it’s not enough - both in my opinion and in the opinion of most people with whom I spoke (however, they often added “why do you need this?”, Which really infuriates me, because this is a childhood dream. Not I should have told you about the syndrome, I’m too suspicious - now I’m walking, I’m thinking... I’ll repeat the question - how to improve the proportions (in addition to the pool) is the scheme of 3-4 workouts in the pool and 2 in the gym per week suitable for me, is it worth it? Taking HGH, what is the probability of closing the growth zones (I have hardly grown for the last 2 years) and expanding the bones, respectively?
A photo is attached to the question
The hormone is definitely not. The scheme is suitable, in the gym there are only basic exercises for 8-10 repetitions, no less. The structure of the skeleton is genetic, but there is a so-called the reaction norm can be changed within certain limits, but with the help of muscles (later) it is quite possible. Growth zones can only be checked with an x-ray; once again, I do not recommend it, due to the lack of meaning. The exercises are the same in any case. Good luck!
anonymously
How many cm in shoulders and chest, for example, can I count on?
It is quite possible to increase your chest circumference by 20 cm. But it's better after 18 years. Now is a period of growth, including internal organs and the heart. Overload is undesirable, and training for mass requires enormous loads. Concentrate on swimming, speed, all strokes. The visible result will be in a year. Good luck!
Consultation with a fitness trainer on the topic “Growth of the shoulders and pelvis in a teenager” is given for informational purposes only. Based on the results of the consultation received, please contact a specialist, including to identify possible contraindications.
