Bone age of the child. X-ray examination of the hand Bone age is not important for

BONE AGE(syn. "skeletal" age) - the age of a person, determined by the state of the skeletal system.

In a normally developing organism, there is a direct correspondence between the degree of development of the skeletal system and the age of a person. It matters in clinic, especially at dynamic supervision, and in court. - medical. practice. The main indicators of age-related differentiation of skeletal bones are the appearance of ossification nuclei and the onset of synostoses (table), the size of the bones and their appearance, the nature of the microstructure and the mineral composition of the bone tissue (see Bone).

V. is determined by a combination of signs: in newborns and children from 1 to 3 years, along with the degree of differentiation of the skeleton and the size of the tubular bones and skull, the nature of the overgrowth of fontanelles is taken into account; in children older than 3 years, adolescents and young people with an incomplete process of skeletal formation - the timing of the appearance of ossification nuclei and the onset of synostoses, the size of tubular bones and the head, the degree of overgrowth of the sutures of the vault and base of the skull, the nature of the articulating surfaces of the bones and the microstructure of the bone tissue, as well as terms of eruption of teeth (see) and degree of their erasure. The incompleteness of the formation of the skeleton is evidenced by the non-closure of the sutures of the cranial vault and its facial region, the presence of characteristic striation in the symphysis area, the iliac crest, as well as the upper and lower surfaces of the vertebral bodies (Fig. 1). To study the state of ossification, radiographs of the hand and distal forearm are most often used (Fig. 2 and 3). At the same time, it should be taken into account that due to the acceleration observed in recent decades, the timing of the appearance of ossification nuclei and the onset of synostoses differ significantly from similar data in the 30-40s of the 20th century.

In adults and the elderly, V. to. is established by dystrophic changes in bone tissue, characterized by osteoporosis and associated changes in the microstructure of bone tissue and often its mineral composition; bone growths (including osteophytes, Heberden and Bouchard nodes) in the interphalangeal joints of the hand, joints of tubular bones and vertebrae and the deformity of the joints developing in connection with this (more often after 40-45 years); increased relief of the bone in the places of attachment of ligaments and tendons; overgrowth of the sutures of the skull; changes in the shape, appearance and weight of certain bones, etc. Involutive signs appear by the age of 40-45 and progress with age. Bone growths of the distal phalanges of the hand (Fig. 4) are observed in men starting from 40-45 years old, in women - from 45-50 years old. The olive-like tuberosity of the distal phalanges is gradually replaced by a mushroom-shaped one (Figs. 5 and 6).

The timing and intensity of overgrowing of the sutures of the skull depend on a number of reasons, including its shape: with dolichocephaly (long-headedness), synostosis begins somewhat earlier and proceeds more intensively than with brachycephaly (short-headedness). Complete obliteration of the sutures of the cranial vault occurs more often by the age of 60-70. Thinned, in the form of a narrow plate, the horseshoe shape of the lower jaw is characteristic of the elderly and senile age.

To determine V. to, a complex of various methods is used: anatomical and morphological, radiological, osteometric, microscopic and spectrographic.

Bibliography: Burov S. A. and Reznikov B. D. Features of ossification of the hand and distal forearm and their significance in determining age, Sud.-med. examination, No. 15 p. 21, 1972; Burov S.A. and Reunov V.M. The problem of acceleration in forensic medicine, Trudy Saratovsk. honey. in-ta, v. 60, p. 158, 1969; Vinogradova T.P. Some senile changes in bone and cartilage substance, in the book: Probl, geront. and geriatrician, in orthotop, and traumat., ed. M. V. Volkova, p. 46, Kyiv, 1966; Neklyudov Yu. A. On the stability of the radiographic structure of the nail phalanges of the hand, in the book: Sud.-med. expertise and forensics in the service of the investigation, ed. A. S. Litvak, p. 635, Stavropol, 1967; Nikityuk B. A. Modern ideas about the aging of the skeleton, in the book: Morph, man and animals, Anthropology, Results of science, ser. biol., p. 5, Moscow, 1968; Podrushnyak E.P. Age-related changes in human joints, Kyiv, 1972.

V. I. Pashkov.

DETERMINATION OF BONE AGE IN CHILDREN USING ULTRASOUND METHOD

RESEARCH

Alekseeva L.N., Kharenko I.V., Maslov A.A.

Introduction.

The generally accepted and reliable criterion for the degree of biological development both in prenatal life (from the 4th-5th month of intrauterine development) and in all subsequent periods of postnatal ontogenesis is the so-called bone age. The generally accepted method of its determination is the age terms of the appearance of ossification nuclei of the distal epiphyses of the bones of the forearm, the heads of the short tubular bones of the hand and the bones of the wrist, determined by radiography of the hand in a direct palmar projection. One of the significant drawbacks of this method, especially when used in pediatric practice, is the presence of radiation exposure on the child's body. It is also important that there are technical and economic problems in the use and processing of X-ray film. This provision determined the purpose and objectives of this study.

Material and research methods.

In order to study the possibility of an ultrasound method for determining bone age in children in the Department of Ultrasound Diagnostics of the ChODKB, we examined 109 children aged 2 months and older. up to 14 years, among which there were 61 (56%) boys and 49 (44%) girls. Patient selection was determined by prior medically indicated hand x-rays and possible follow-up by ultrasonographic examination of the wrist and hand. A total of 109 x-ray and 109 ultrasound examinations of the left hand were performed. The total group of patients was divided into six subgroups depending on the regular stages of postnatal development.

miirovaniya elements of the wrist joint and hand.

1. From 0 to 2 years - 20 people.

2. 3-4 years - 16 people.

3. 4.5-7 years - 13 people.

4. 8-9 years old - 22 people

5. 10-11 years old - 22 people

6. 12-14 years old - 16 people.

X-ray was chosen as the reference method, and all children underwent radiography of the left hand in the palmar projection. Also, all children underwent an ultrasound examination of the dorsal surface of the left wrist, metacarpus, distal epiphyses of the radius and ulna. The following were assessed: growth zone of the 1st metacarpal bone (sin 1 met), epiphysis of the 1st metacarpal bone (E1), trapezoid bone (TR), navicular (S), trapezoid (TZ), capitate (C), hamate (H ), lunate (L), trihedral (T), epiphysis of the radius (ER), epiphysis of the ulna (EU), pisiform bone (P) and sesamoid bone of the 1st metacarpophalangeal joint (ses). Additionally, in the age groups of 0-2 and 3-4 years, the epiphyses of the 3rd metacarpal bone and the epiphyses of the proximal, middle and distal phalanges were studied, and in the groups of 8-9,10-11 and 12-14 years - the styloid process of the ulna. To visualize each of the listed objects, an optimal scanning method was developed. In parallel, each ossification nucleus was measured along the long axis between diametrically opposite surfaces of the cortical layer. If ossification had not yet ended, measurements were taken between the corresponding edges of the cartilaginous bone model or her. When analyzing the obtained radiographs, we also carried out

longitudinal measurements of the ossification nuclei in a plane similar to the sonographic measurement using a ruler. In all cases of x-ray examination, the distance from the apparatus to the film was 60 cm, since under these conditions the dimensions of the bones on the x-ray completely coincide with the true dimensions of the bones.

Ultrasound studies were performed on ultrasound scanners PHILIPS HD 11 XE, GE LOGIQ 7 and Mini Focus 1402 using a linear probe with a frequency range of 3-12 MHz. Statistical processing of the obtained data was carried out according to the methods generally accepted in medicine using software packages for statistical analysis: "Exce1" and "Statistica 6.0". Qualitative data were presented in the form of absolute or relative (%) frequencies. For comparison, likhptpmicheg.kih pgzhyayayapyay was used - the association coefficient

Using four-field contingency tables. The significance of the coefficient ^ emp was checked using Student's t-test. The reliability and validity of ultrasound and X-ray diagnostic methods was based on the definition of sensitivity tests.

Rice. 1. An example of trihedral ossification

a, b) C - nucleus of ossification of the trihedral bone

On fig. 2 scanning in the sagittal plane along the axis of the 1st finger in the position of abduction of the 1st finger by 40-50 degrees. The proximal

sti, specificity, overall accuracy. To compare two measurement methods - ultrasound and Rg - on an interval scale, the Blend-Altman method was used. For each measured object, the average value of the relative discrepancies dsr and the standard deviation 17 (dsr) were calculated, followed by testing the hypothesis of a difference in the relative discrepancy Δs from 0. For this, the criterion Student: comparison of the sample mean with the hypothetical general mean.

Results of the study and their discussion.

To identify all the ossification nuclei of the proximal row and most of the distal row of the wrist, we propose to scan the dorsal surface of the hand and wrist in the sagittal plane in two projections: direct and axial (the palmar surface of the wrist in profile). Additionally, we assess the presence of the sesamoid bone of the 1st metacarpophalangeal joint when scanning the palmar surface of the 1st finger.

As an example, Fig. 1 shows sonograms obtained by scanning in the axial plane of the ulnar edge of the wrist.

bones in children aged 2 (a) and 11 (b) years

the epiphysis of the 1st metacarpal bone (E1), its metaepiphyseal growth zone (sin 1 met), the trapezium bone (os trapezium - TR) and the navicular bone (os scaphoid - S). Metaepiphyseal cartilage, including the 1st metacarpal bone, (Fig. 2A - x) on the echogram is determined in the form of hypoechoic

Information and analytical magazine No. 2

noah or anechoic uneven strip with a thickness of 0.5 to 1.5 mm, depending on the age of the child. With echocardiography,

trace the replacement of the metaepiphyseal cartilage with bone tissue and the fusion of all parts of the bone (the appearance of synostosis).

Rice. 2. An example of ossification in children aged 4 (a) and 14 (b) years

a) E1 - the nucleus of ossification of the proximal epiphysis of the 1st metacarpal bone

x - hypoechoic plate of metaepiphyseal cartilage

TR - nucleus of ossification of the trapezoid bone S - nucleus of ossification of the scaphoid bone

The presence of the object of study (there is / is not a core of ossification);

By the quality of the object under study (bone / cartilage structure);

According to the size of the object (mm).

Based on the comparison of X-ray and ultrasound data, the indicators of the diagnostic value of the test were calculated.

It has been established that ultrasound is able to capture the initial manifestations of enchondral ossification, which are not distinguishable by radiography, in the form of hyperechoic inclusions in the center of the cartilaginous model. With complete ossification on the echogram

b) E1 - complete ossification of the proximal epiphysis of the 1st metacarpal bone

TR - cortical plate of the trapezium bone

S - cartilaginous model of the nucleus of ossification of the navicular bone

ER - cortical plate of the epiphysis of the radius

only the cortical plate is distinguishable in the form of a hyperechoic signal that follows the contour of the bone and gives a pronounced acoustic shadow behind it.

When conducting a comparative analysis on the presence of the object of study in the group of 0-2 years old, an average correlation dependence (р< 0,01); в группах от 3 до 9 лет - сильная корреляционная зависимость (р < 0,001); а в группах 10-14 лет - полное соответствие в выявлении ядер окостенения (табл.1) Отсутствие полной идентичности в выявлении ядер окостенения в младших возрастных группах, объясняется большей чувствительностью УЗИ относительно Rg за счет распознавания более раннего появления ядра окостенения на начальных стадиях минерализации хрящевой модели кости.

PEDIATRIC BULLETIN OF THE SOUTHERN URALS

Table 1. Results of a comparative analysis by the presence of the object of study in terms of ultrasound and Rg

Age, years Association coefficient, f Significance of the coefficient, f emp.

0-2 0.97 R< 0,01

3-4 0.95 R< 0,001

4.5-7 0.92 R< 0,001

8-9 0.82 R< 0,001

10-11 1 Full compliance

12-14 1 Full match

When analyzing the diagnostic value of sensitivity, specificity, and exact test, high rates were obtained in all study groups (Table 2).

Table 2. Evaluation of the prognosis of ultrasound to identify the object of study

Age, years Sensitivity Specificity Predictive value Accuracy

Positive result Negative result

0-2 100% 97,9% 95,5% 100% 98,5%

3-4 100% 91,8% 97% 100% 97,8%

4,5-7 100% 90% 99,2% 100% 99,3%

8-9 100% 70% 97,4% 100% 97,6%

10-11 100% 100% 100% 100% 100%

12-14 100% 100% 100% 100% 100%

The obtained data on the quality of but x-rays in an earlier register-detected object reflect the general ion of the initial signs of ossification, the pattern of echography is relative (Table 3).

Table 3. Results of a comparative analysis of the quality of the object under study

(bone/cartilage) by ultrasound and Rg

Age, years On ultrasound there are initial signs of ossification, on Rg there are no ultrasound and Rg: there are signs of ossification Ultrasound and Rg: there are no signs of ossification

Abs. number of measurements % Abs. number of measurements % Abs. number of measurements %

0-2 4 1,4% 85 30.4% 191 68,2%

3-4 5 2,2% 163 72,8% 56 25%

4,5-7 3 2,1% 120 83,9% 20 14%

8-9 7 2,4% 263 92 % 16 5,6%

10-11 - - 307 93% 22 7%

12-14 - - 224 100% - -

Information and analytical magazine No. 2

When conducting a comparative analysis of two measurement methods, the Blend-Altman method was used to identify a systematic measurement error.

In the first five age groups from 0 to 11 years, no systematic error was detected, and the discrepancies do not differ significantly from 0. In the fifth age group (12–14 years), significant differences in measurements (p< 0,01) по трапециевидной кости (TZ), эпифизу лучевой кости (EU) и эпифизу 1-й пястной кости (Е1). Это можно объяснить практически полным окостенением структур лучезапястного сустава в данном возрасте и, как следствие, взаимным наложением контуров кортикальных пластинок костей. Иногда это приводит к неточностям измерений. В отношении зоны роста также были выявлены значимые различия. что, на наш взгляд, обусловлено меньшим шагом измерения на УЗИ и вследствие этого более высокой точностью (в сравнении с использованием обычной линейки при анализе рентгенограмм).

Conclusion.

Thus, ultrasonography of the wrist and hand skeleton can be used to determine bone age in children. The relative simplicity of the proposed method and absolute safety for the child's body allow it to be widely used in clinical practice.

1. Ultrasound is a highly informative and widely used method for assessing bone age in children.

2. The method proposed by us has high sensitivity, specificity and accuracy in children from 0 to 14 years old.

3. Conducted X-ray sonographic comparisons made it possible to establish that all objects necessary for determining bone age are detected on ultrasound, as on x-rays. Ossification points corresponding to non-mineralized or weakly mineralized bone tissue appear earlier on ultrasound.

TREATMENT OF CONGENITAL CLUBFOOT IN CHILDREN ACCORDING TO PONSETI

Berintsev V.G., Selivanova T.A., Ivanova E.G.

GBUZ "Chelyabinsk Regional Children's Clinical Hospital"

The results of the treatment of congenital clubfoot, despite the large number of proposed treatment methods, do not always satisfy the patient and the doctor. The frequency of relapses, according to the authors, varies from 30% to 64%.

Research objective: To improve the results of treatment of congenital clubfoot in children.

Materials and methods of research:

Since March 2008, the Ponseti method has been applied. For 2 years 9 months, 234 children (342 feet) were treated, of which 151 (64.5%) boys and 83 (35.5%) girls. Age of children from 6 days to 5 years. Atypical clubfoot (according to Ponseti) occurred in 16 children. If until 2009 staged plastering according to Pon-

networks were first started in 31 children (43%) out of 71, then after 2009 - in 96 children (68%) out of 142. 46 (32%) patients before treatment according to Ponseti underwent staged plastering according to the classical method. However, the deformity could not be eliminated, and the children were sent for surgical treatment. 9 patients were treated due to relapse after the Zatsepin-Sturm operation and ChKDOS according to Ilizarov. Ponseti treatment was carried out in compliance with all the principles of the method. The number of stage plaster casts varied from 3 to 8 and depended on the age of the patient and the presence of concomitant pathology (arthrogryposis, systemic diseases). Before applying the final plaster cast in most cases

X-ray examination is the most reliable way to detect pathological conditions in the body, which makes the X-ray of the hand indispensable in the general diagnosis of injuries and injuries, including those of a degenerative-destructive nature.

Indications and contraindications for implementation

X-ray diagnostics makes it possible to detect the disease at the initial stage of its development and more accurately identify possible complications. Based on X-ray diagnostics, the doctor prescribes adequate therapy aimed at eliminating the symptoms of the disease.

The main indications for radiography of the hands are injuries, as well as pathological processes, during which the left or right hand can undergo serious deformities. In addition, X-ray examination is recommended in the following cases:

• the presence of pain symptoms in the hands;
• swelling and redness of the joints;
• various deformities of the joints;
• suspected bone fracture;
• inflammatory process in the wrist joints (arthritis and arthrosis);
• destructive disorders of bone tissue (osteomyelitis);
• benign and malignant neoplasms;
• joint anomalies that are inherited.

Hand x-rays are not recommended for pregnant women and children under 15 years of age. However, in extreme cases, if there is a real threat to the patient's life, the doctor may prescribe such an examination, making an exception. In other cases, an MRI is prescribed.

The main pathologies of the hands

The x-ray shows the following signs:

• synovitis - accumulation of fluid in the carpal joints, which manifests itself in the picture in the form of a slight expansion of the joint space;
• calcifications are an early radiological sign of arthritis;
• tendinitis and tenosynovitis- the result of an x-ray image manifests itself in the form of seals and thickening of the wrist, which is due to the involvement of the ligamentous apparatus in the inflammatory process;
• osteoporosis is an early, but not specific, radiographic symptom of the development of polyarthritis. In the picture, it manifests itself as a thinning of the cortical layer of the diaphysis of short tubular bones;
• cysts - radiologically defined as multiple rounded formations located in the central or subchondral parts of the bone epiphysis;
• osteophytes - in the picture it is defined as a bone growth of the edge of the joint surface in the form of a sharp spike;
• subchondral osteosclerosis- this radiological sign is detected during advanced processes and is characterized by a narrowing of the joint space due to friction of the bone joints;
• joint erosion - such a symptom can be detected in chronic polyarthritis.

Osteophytes on fingers

It is important to remember that small joints, including the hands, are the main targets for quite a few inflammatory systemic diseases, when X-ray examination can detect pathology at the initial stage of its occurrence.

In addition, radiography of the hand is necessary for an adequate assessment of damage not only to the bone structure, but also to soft tissues (calcification). In this case, their compaction and thickening are noted on a standard x-ray.

Soft tissue calcification of the hand

Preparation for the procedure

Most often, radiography is the norm, which is included in the diagnostic standard, and is mandatory for any bone damage. It allows you to find out the severity of damage to bone and muscle tissue, regardless of which area is damaged, including the right or left hand, foot, knee or elbow joint.

Before performing the examination, preliminary preparation of the patient is necessary:

• before starting the procedure, it is necessary to remove all jewelry (watches, bracelets, rings), the presence of which adversely affects the quality of the image and the determination of the subsequent result;
• it is necessary to remove the bandage and iodine residues from the area under study, as well as traces of the adhesive plaster;
• the question of the need to remove the cast before X-ray diagnostics is decided by the attending physician, who will give all the necessary advice on further immobilization of the limb.

Important! X-rays during a woman's pregnancy are performed under the supervision of a doctor and only if the risk to the mother's health outweighs the risk to the baby.

Survey tactics

In all cases of X-ray examination, a special lead-coated apron is put on the patient, which reduces ionizing radiation.

When taking a picture of the hand in young children, only the part of the body to be examined is left open. The result of X-ray diagnostics in a child is compared with the bone age standard, which is indicated by a special table.

A brush shot is taken within 3-5 minutes. In this case, the patient is asked to straighten the fingers of the hand so that they are located on a special surface (cassette). The radiologist must take into account that the location of the hand must coincide with the axis connecting the forearm and wrist.

Scanning of the hand is performed in a sitting position, while the arm should be bent at the elbow joint, and the hand itself should be placed on the cassette of the x-ray machine. On how correctly the brush lies when taking a picture, its accuracy and information content depend.

The picture can be taken in several projections (front and side), which allows you to get more reliable information. If necessary, the doctor can change the ways of laying the brush, which differ from each other.

If it is necessary to make the x-ray examination of the wrist area more accurate, the following hand positions are used:

Direct projection

This position can be performed in 2 versions (palmar and back). With a direct projection, the palm should be placed horizontally on the cassette so that the x-ray beam passes strictly through the middle of the hand, perpendicular to the cassette.

Lateral projection

In this case, the hand is placed on the cassette with the ulnar edge (rib), and the thumb of the person is slightly retracted forward. When photographed in a lateral projection, the contour of the wrist, phalanx and metacarpal bones is most well defined. Most often, such a projection is used in traumatological practice, which makes it possible to identify the displacement of the bones of this area.

A - the location of the hand in a direct palmar projection for the picture, B - the location of the hand in the lateral projection of the radiography of 2 fingers

Oblique palmar projection

This way of laying the brush best visualizes the trapezius and scaphoid bones. Oblique palmar projection provides for the position of the hand on the cassette with the palmar surface so that an angle of at least 45 degrees is formed.

Oblique rear projection

In this case, the brush should be positioned so that its back forms an angle of 45 degrees with respect to the cassette. The radiograph clearly shows damage to the pisiform, trihedral, hooked, as well as 1 and 5 metacarpal bones.

Additional styling

In addition, there are several additional stackings to better visualize individual bones, such as the scaphoid or pisiform. Panaritium, joint damage of an inflammatory nature (arthritis and arthrosis) is visualized in isolation. In this case, the area for the picture is separated from healthy tissue by a special protective apron that does not transmit X-rays.

Additional stacking can be used to detect the following damage:

• the first finger of the hand - such a picture is taken in the lateral and direct projection. To take a picture in direct projection, you need to put your thumb on the cassette with the back side. For a picture in a lateral projection, the finger is located on the cassette with a radial edge. The picture reveals damage to the wrist, phalanx of the finger and 1 metacarpal bone;
• second - fifth finger - in this case, lateral and direct projection are also used. With direct projection, the injured finger is placed on the cassette for the image with the palm side, and with lateral projection - with the side. The picture clearly shows the phalanges of the fingers and the state of the joint space of the interphalangeal joint.

X-ray radiation is one of the most accurate and necessary methods for diagnosing diseases of the joints. The effectiveness of such a study is confirmed by doctors, and modern equipment used in diagnostics makes it possible to examine the hands in more detail, which allows you to choose the most appropriate method of treatment.

BONE AGE
essential for a comprehensive assessment
growth. The degree of skeletal maturation
be judged on different bones, but
the most widespread
x-ray examination of bones
brushes. This is due to the presence in this
areas of many ossification centers, which
allows you to identify different
stages of skeletal maturation
throughout the growth period.

Methods for assessing bone age:

Buchman method (common in Russia):
x-rays are taken of both
hands with wrist joints and
special tables according to gender
the child is determined by the age range,
which corresponds to the quantity
ossified nuclei with one or the other
sides

Greulich-Pal method: assessment by radiograph
one left hand with a wrist joint.
Bone age is determined by
atlas by comparison with photographs and
descriptions of radiographs, which in certain
age periods differ not only
the number of ossification nuclei, but also their size and
mutual disposition. After selecting from the atlas
most similar x-ray picture with
using tables to estimate the age of each
individual bone, and then calculate the average
index.

Tanner-Whitehouse method: also
use x-ray of the left hand and
wrist joint. In accordance with
attached descriptions and drawings
alternately assess the degree of maturity 20
ossification centers, and then
the corresponding formula calculate
bone age.

X-ray of the unchanged hand and wrist: 1 - trapezoid, 2 - trapezoid, 3 - capitate, 4 - hooked, 5 -

X-ray of unchanged
hands and wrists:
1 - trapezoid,
2 - trapezoid,
3 - capitate,
4 - hooked,
5 - scaphoid,
6 - lunar,
7 - trihedral

Hand radiographs

Hand radiographs

Up to 3 years
3 years
9 years
16 years

Radiographs of unchanged pelvic bones in children of different ages: a - a 10-month-old child; b - a child of 3 years; in - baby 7

years;
g - child 10 years old

Radiographs of unchanged knee joints in a newborn (a) and an 8-year-old child (b): a - in a newborn

Radiographs of normal knee joints in a newborn (a)
and a child of 8 years old (b):
a - in a newborn, only ossification nuclei are determined in the epiphyses of bones,
forming a joint (arrows). The patella is radiographically
visualized;
b - in an 8-year-old child, preserved growth zones (arrows) are determined on
border between the epiphysis and metaphyses. The patella is clearly defined (double
arrow)

It should be noted that the study of bone age itself is of relative importance. Bone age may

differ from chronological
only with different
diseases, but also in healthy children, in
which this difference is sometimes 2-3
of the year.
At the same time, comparison of bone
age with the growth of the child, especially in
dynamics, can give a very valuable
information about further growth
forecast.

> Determination of bone age

This information cannot be used for self-treatment!
Be sure to consult with a specialist!

What is bone age?

Bone age is a conditional age, which corresponds to the level of development of the bones of the child. It can be established by X-ray examination. There are special X-ray tables that combine normal indicators of bone age in children and adolescents. They take into account the weight and length of the child's body, chest circumference and stage of puberty.

There are several methods for determining bone age, taking into account the time of appearance of the epiphyses (the end sections of tubular bones), the stages of their development, the processes of fusion of the epiphyses with the metaphyses with the formation of bone joints (synostoses). These processes are especially indicative in the bones of the hands due to the presence in them of a large number of epiphyseal zones (areas of growing tissue in the bones) and ossification nuclei.

Normally, in young children, the proportion of cartilage tissue in the anatomical structures of the skeleton significantly exceeds that in adults. In a newborn child, the epiphyses of the tibia, femur and other bones, some bones of the foot (heel, talus, cuboid), spongy bones of the hand, as well as the vertebral bodies and their arches, consist of cartilaginous tissue and have only ossification points. As the child grows, dense bone tissue gradually replaces cartilage. Ossification points in cartilage appear in a certain sequence.

Indications for determining bone age

Indications for the study are violations of the physical development of the child, slowing down his growth, some diseases of the pituitary gland, hypothalamus and thyroid gland.

They are most often referred for examination by pediatricians, endocrinologists, orthopedists. You can pass it both in the x-ray room of the clinic, and in any paid center equipped with an x-ray machine.

Contraindications for this study

X-ray examination of children under 14 years of age due to the negative effects of ionizing radiation on a growing body should be carried out only as prescribed by a doctor. It is not recommended to repeat it earlier than after 6 months. Special preparation for the procedure is not required.

Methods for determining bone age and decoding the results

To determine bone age, an x-ray of the hand and wrist joint is most often performed. The radiologist compares the results obtained with the standards defined for the given age of the child. Growth and physical development delays associated with the pathology of the pituitary gland are characterized by a significant lag of bone age from the real one (more than 2 years). In genetic short stature and skeletal dysplasia, there is usually little or no delay in bone maturation.

Features of the skeleton, in addition to age, also have gender features. Girls, as a rule, are ahead of boys in development by about 1-2 years. Sexual characteristics of the rate of ossification usually appear starting from the first year of a child's life.

Based on x-ray data, it is possible to assess the dynamics of puberty. The appearance of a sesamoid bone in the metacarpophalangeal joint indicates an increase in the function of the gonads. The ossification of the metacarpal bone corresponds to the appearance of menses in girls and regular wet dreams in boys. Between these events, there is a "growth spurt", when the length of the body increases especially rapidly. With various forms of premature sexual development, the process of bone maturation is accelerated, and with pituitary dwarfism (a decrease in the synthesis of growth hormone), it slows down.

X-ray examination of the bones of the skull is most often carried out in order to diagnose the pathology of the Turkish saddle, indicating diseases of the pituitary gland. With pituitary dwarfism, a decrease in the size of the saddle is revealed, with tumors of the pituitary gland - thinning of its walls and expansion of the entrance, as well as foci of calcification. For craniopharyngioma (an intracranial tumor originating from the cells of the pituitary gland), the characteristic features are the divergence of cranial sutures and pronounced "finger" impressions on the inside of the skull.

The results of radiography must be shown to the doctor who referred for this study.