Bone age according to the radiograph of the hand decoding. What should be the height of my child when he grows up - we calculate according to the height of the parents

In medical terminology, bone age is understood as the conditional value of age, the level of which corresponds to the development of the bones of the skeleton of the child being examined. It is possible to find out the bone age during an X-ray examination, when, according to specially designed tables, specialists compare the normal values ​​\u200b\u200bof the bone age indicators of adolescents or children with those that they can see in a particular patient. These tables necessarily take into account not only the height and weight of a person, but also the circumference of the chest, as well as the period of puberty in which the child is at the time of the examination.

Features of the procedure

For a competent determination of bone age in medicine, there are several basic methods that take into account the emergence of the epiphyses or the end sections of the tubular bone, the stages of development of this process (growth zones), the fusion of the epiphyses and metaphyses, the formation of synostoses or bone joints. Since there are a large number of ossification nuclei and growing bone tissue or epiphyseal areas in the hands, bone age is very often determined precisely by examining the hands.

Usually in children, the norm of the share of cartilage tissue is much higher in the skeleton than in adults. So, for example, newborns have cartilaginous tissue in most bones in the skeleton - the epiphyses of the calcaneus, tibia, femur, talus, cuboid, spongy on the hand, as well as vertebrae - consist of cartilaginous tissue and only rely on ossification points. With the development and growth of the body, cartilage tissue is replaced by bone tissue in a sequence determined by nature.

Indications and contraindications for diagnostics

The main indications for a study to determine the bone age of a child are various disorders in his physical development, slow growth, diseases of the pituitary gland, thyroid gland and hypothalamus. At the same time, specialists such as sending the patient for an x-ray examination in any medical institution where there is an x-ray machine are dealing with the problem.

At the same time, by X-ray examination of the hand, it is possible to determine, for example, the presence in the child's body of such pathologies as pituitary dwarfism or dwarfism as a result of growth hormone deficiency, early puberty, impaired bone development due to genetic disorders, such as:

• Shereshevsky-Turner syndrome;
• congenital adrenal hyperplasia.

Among the main contraindications to conducting a study to determine the bone age of a child, doctors single out the age of up to 14 years, when such a procedure can be carried out only on the recommendation of the attending physician. Also, this examination cannot be repeated more often than once every six months, due to strong X-ray radiation, which is harmful to a fragile organism. It is important to remember that the patient does not need to carry out any specialized preparation for the study.

Research methods and results

To correctly determine the patient's bone age, radiographs of the wrist and hand are most often used. During the study, the specialist analyzes and compares the picture that he sees on the x-ray with the data that are recognized as the norm in this age group.

With diagnosed and possible pathologies of the pituitary gland, physical development is largely behind the real age indicators of the child. This delay can sometimes reach up to two years. But when diagnosing skeletal dysplasia or genetically determined short stature, bone growth retardation is usually absent or expressed by minimal indicators.

Also, when diagnosing the human skeleton, it is important to remember that it has not only age, but also gender characteristics. So, for example, the female skeleton develops significantly, sometimes by 1-2 years, faster than the male. Such features of ossification, which depend on sexual characteristics, manifest themselves from the first year of a child's life.

Thus, on the basis of x-ray data, one can judge the stage of puberty at which the patient is at the time of the examination. By the appearance of a sesamoid bone of the metacarpophalangeal joint, one can judge the increased function of the gonads in the body, with ossification of the metacarpal bone, menstrual cycles begin in girls, and regular pollutions in boys.

At the same time, a growth spurt is observed when the body length increases very sharply in a short period of time. With precocious puberty, we can talk about the development of the process of bone maturity, and with reduced synthesis of growth hormone or pituitary dwarfism, it slows down.

In the study using the pathological condition of the Turkish saddle is revealed, which indicates endocrine diseases. Pituitary dwarfism is characterized by a decrease in the size of the saddle, with neoplasms in the pituitary gland, its walls become thinner, the entrance expands and places of calcification appear. In the presence of an intracranial tumor that originates from the pituitary cells - craniopharyngiomas - the cranial sutures diverge and depressions appear on the inside of the child's skull.

Any results of radiography must be provided to the specialist who referred the patient for analysis, so that he can diagnose the disease in a timely manner and prescribe effective therapy.

Speciality: pediatrician, infectious disease specialist, allergist-immunologist.

General experience: 7 years .

Education:2010, Siberian State Medical University, pediatric, pediatrics.

Over 3 years of experience as an infectious disease specialist.

He has a patent on the topic "Method for predicting a high risk of developing chronic pathology of the adeno-tonsillar system in frequently ill children." And also the author of publications in VAK magazines.

Sweaty feet! Horror! What to do? And the way out is very simple. All recipes that we give are tested first of all on ourselves and have a 100% guarantee of effectiveness. So, get rid of sweaty feet.

There is much more useful information in the history of the patient's life than in all the encyclopedias of the world. People need your experience - "the son of difficult mistakes." I ask everyone to send prescriptions, do not spare advice, they are a ray of light for the patient!

About the healing properties of pumpkin Ingrown nail I am 73 years old. Sores appear such that I did not even know that they existed. For example, on the big toe, a nail suddenly began to grow. The pain kept me from walking. They suggested surgery. In "Healthy Lifestyle" I read about pumpkin ointment. I cleaned the pulp from the seeds, applied it to the nail and bandaged it with polyethylene so that the […]

Fungus on the legs Fungus on the legs Pour hot water into the basin (the hotter the better) and rub laundry soap in the water with a washcloth. Hold your legs in it for 10-15 minutes to steam them properly. Then clean the soles and heels with a pumice stone, be sure to trim your nails. Wipe your feet dry, dry and lubricate them with a nourishing cream. Now take a pharmacy birch […]

For 15 years, my foot has not bothered me. Callus on my leg For a long time, I was bothered by a callus on my left foot. I cured him in 7 nights, got rid of the pain and began to walk normally. It is necessary to grate a piece of black radish, put the gruel on a rag, firmly tie it to a sore spot, wrap it with cellophane and put on a sock. Compress is desirable to do at night. To me […]

Young Doctor Prescribed His Grandmother's Prescription Gout, Heel Spurs I'm sending you a prescription for a heel spur and lumps near the big toe. It was given to me by a young doctor about 15 years ago. He said: “I can’t write out a sick leave certificate for this, it’s not supposed to. But my grandmother was treated for these troubles in such a way ... ”I took the advice […]

Let's start with gout, which is caused mainly by a violation of metabolic processes. Let's listen to what the Vinnitsa doctor D.V. NAUMOV says about padagra. We treat gout according to Naumov Gout "healthy lifestyle": There are a lot of questions about the dissolution of salts in the joints. You claim that the food salt that we use inside has nothing to do with insoluble salts such as urates, phosphates and oxalates. And what has […]

On the advice of Antonina Khlobystina Osteomyelitis At the age of 12, I fell ill with osteomyelitis and almost lost my leg. I was admitted to the hospital in a serious condition and operated on the same day. He was treated for a whole month, and was deregistered only after 12 years. I was cured after all by a simple folk remedy, which was suggested to me by Antonina Khlobystyna from Chelyabinsk-70 (now […]

Fell, woke up - gypsum Over the years, the bones become very fragile, osteoporosis develops - women especially suffer from this. What to do if you have a fracture? How can you help yourself besides plaster and bed rest? With these questions, we turned to Doctor of Biological Sciences, Professor Dmitry Dmitrievich SUMAROKOV, a specialist in bone tissue restoration. "ZOZH": You are 25 years […]

Onion soup against osteoporosis Osteoporosis Doctors call osteoporosis the "silent thief". Quietly and without pain, calcium leaves the bones. A person has osteoporosis and knows nothing about it! And then unexpected bone fractures begin. A 74-year-old man was admitted to our hospital with a hip fracture. He fell in an apartment out of the blue - the bone could not withstand the […]

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:

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

Hand radiographs

Hand radiographs

10.

11.

12.

Fig. 13. 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

Fig. 14. Radiographs of unchanged knee joints in a newborn (a) and an 8-year-old child (b): a - in a newborn

15.

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

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.

> Determination of bone age

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

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.