Synostosis is a phenomenon when bones are excessively fused with each other. This pathology arises for various reasons. The most common form is a genetically determined form of the disease, much less often acquired (it may result from injuring bones and their improper fusion or created by surgery).
Syndesmosis, synchondrosis, synostosis are types of bone connection.
Types of synostosis
Typically, synostosis is classified by species depending on the cause of its occurrence. But all of them can be conditionally divided into the following groups:
- Physiological. It develops in the process of human growth. In this case, the precursors of synostosis are usually synchondrosis, which are characterized by ossified cartilage at the junction of bones. Thus, joints arise between the pelvic bones, sacral vertebrae, and bones in the sacral region. These bone joints are motionless.
- Pathological synostosis is a phenomenon that always acts as a complication against a background of another pathology.
The latter species, in turn, is divided into several subspecies.
Genetic synostosis
It arises as a result of a partial or complete absence between the bones of the connective tissue. The most frequent localization of such a pathology is between the radius and ulna. In the normal state, they are connected by a special tissue membrane. More rarely there are cases of untimely tightening of the sutures on the skull in children, as well as fusion of the carpal bones. Anomalies can occur in other parts of the human skeletal system.
Post-traumatic synostosis
Post-traumatic synostosis is a disease that occurs against the background of an injury resulting in damage to the periosteum, a large area of bone tissue or an area of bone growth. According to statistics, the most common is the fusion of the bones of the forearm and lower leg or in the intervertebral space. There is synostosis of the ribs.
The main reason for this type of pathology is the proximity of the bones to each other at the site of injury. As a result, active tissue repair leads to bone marrow, which should not be in a normal state.
Artificially created synostosis
Artificially created synostosis is a phenomenon, the need for which arises during surgical intervention, the purpose of which is to restore the leg in the leg. This technique allows you to reduce the load on the leg, redistributing it to the tibia, allowing the patient to walk normally in case of injury. Thus, a compensatory increase in the tibia is formed under the influence of a greater load. The patient will be able to move independently in the future.
This classification does not allow to take into account all types of synostosis. It does not include pathologies associated with bone adhesions, the causes of which are:
- Osteomyelitis (inflammation of the bone marrow canal).
- Bone tuberculosis.
- Complications after brucellosis and typhoid fever.
- Osteochondrosis.
Below we will consider some more specific types of synostosis.
Forearm synostosis
This type of pathology is otherwise called radio lunar synostosis. It can be found in any part of the forearm, but most often it is localized in the closest to the humerus. This location of the disease is due to the fact that the radial and ulnar bones, even normally, have a special structure and are closely adjacent to each other.
Synostosis can be of different lengths, from 1 to 12 centimeters. In the initial stages, the development of pathology is latent. The most striking sign of synostosis is the low mobility of the affected bones, becoming more and more with the development of the disease. Pathology is accompanied by slow muscle atrophy of the hand and forearm. Patients with this diagnosis are limited in their choice of professional activity. Becoming a jeweler, dentist, or mastering any other profession that requires high-precision hand movements will fail.
Also, one of the signs of bone synostosis is the enlargement of the ulnar process. This occurs as a result of load compensation. Curvature in the forearm, however, does not occur, that is, aesthetic defects are not observed.
Patients with this diagnosis cannot make circular movements with the forearm, it is motionless and slightly turned inward. This complicates the process of self-care, and as a result, the patient cannot:
- Take in the palm of your hand an object.
- Get dressed.
- Write with an affected hand.
- Carry a plate and use cutlery.
Diagnostics
To make the correct diagnosis, it is necessary to conduct an x-ray examination. Thus, it is possible to most accurately see the site of bone fusion. Therapy occurs in two stages: conservative and operational. Treatment must be started in a timely manner to avoid muscle atrophy. The conservative treatment phase cannot be carried out in children under three years of age. This stage of therapy involves the following measures:
- Applying casts of plaster, which over time will change the direction of the bones.
- The duration of each bandage is two weeks.
- Performing a special therapeutic complex of exercises and massage.
This stage can last from 6 to 10 months. From 4 to 6 years, it becomes possible to carry out an operation, the task of which is to get rid of synostosis and place the bones of the forearm in the correct position, advantageous in terms of functionality. Other examples of synostosis are presented below.
Craniostenosis - untimely synostosis of the cranial bones
This pathology occurs in one case out of two thousand. More often, boys become victims of this disease. Craniostenosis is dangerous in that it often occurs in combination with congenital heart disease. No less dangerous and increased intracranial pressure. It occurs against the background of a limited volume of the cranial cavity of a child at an age when it should still grow. Such a restriction may adversely affect overall mental development. There are no exact data on the causes of sagittal synostosis. This can be both genetic pathologies and intrauterine infectious diseases, which can cause a malfunction in the formation of the infant's skeletal system.
Symptoms
Craniostenosis sometimes begins to develop in utero. In this case, the course of the disease will be severe. In such children, a clear deformation of the cranium is observed. One and several seams can grow together. Craniostenosis is manifested by the following symptoms:
- Dizziness.
- Vomiting and nausea.
- Headache.
- Convulsive syndrome.
- An increase in veins on the head.
- Sleep disturbances.
- Chronic drowsiness.
- Disorders of the psyche and memory.
- Strabismus, falling into the eyeball and other manifestations of eye pathologies.
The correct diagnosis in the case of craniostenosis is not a problem. The x-ray gives a fairly clear picture: it clearly shows that there are no seams between the cranial bones. The method of therapy in this case is surgery, which involves excision of bone fusion. Symptoms are treated as they occur.
Clippel Syndrome - Feil
It was described by doctors of the same name. This is a congenital disease for which the following symptoms are characteristic:
- Short neck.
- Vertebral synostosis in the cervical region, which prevents the patient from turning or tilting his head.
- The border of the hair on the back of the head is low.
Pathology occurs during fetal development. Its appearance is associated with incorrect formation of blood vessels and future vertebrae. As a result, the cervical vertebrae enter the stage of synostosis and instead of the prescribed 7 only 4-5 are obtained. In addition, the vertebrae of the upper thoracic region can also grow together. However, the bodies and arches of the vertebrae do not grow together. A characteristic feature of this type of synostosis is the immobilization of the neck and head. With this symptom, patients most often see a doctor. In a third of cases, Klippel-Feil syndrome manifests itself with other pathologies. In this regard, in the diagnosis of this syndrome, the following diseases can be identified:
- Torticollis.
- Scoliosis.
- Shoulders located high or pterygoid.
- Underdevelopment of the thumbs.
- The joint of the fingers and toes .
- An abnormal number of fingers.
- Underdeveloped sternum muscle and weakness in the arms.
- Curvature of the feet.
- Lack of ular bone on the elbow.
Forecast
The life expectancy of people with such a pathology depends on the combined defects of internal organs and systems. Often, such pathologies lead to dysfunction of internal organs and systems. Quite often, along with the syndrome, they are diagnosed:
- Absence or underdevelopment of the kidneys.
- Hydronephrosis.
- Damaged septa between the ventricles.
- Incorrect location of the ureters.
- Oriented to the right side of the aorta.
- Underdevelopment or lack of lung.
- The duct between the pulmonary artery and the aorta does not overgrow.
Neurological manifestations play an important role in the diagnosis of the syndrome. This is due to the fact that the spine is formed incorrectly and compresses the nerve endings. Therefore, during the examination, special attention is paid to the following symptoms:
- Involuntary movements of hands and brushes.
- Numbness and other sensory disturbances.
- Pain in the back.
X-ray allows you to clarify the diagnosis. It shows a narrowing of the spinal canal, fusion of the cervical vertebrae among themselves and non-growth of arches. Therapy can be performed both operatively and conservatively. Traditional methods include increasing physical activity on the head and neck with the help of special sets of exercises.
More effective, as practice shows, is the surgical method. It involves plastic surgery in the form of resection of the ribs in the cervical spine.
Many are interested in the question of which doctor is involved in the treatment of the above pathologies. In most cases, treatment of synostosis is performed by an orthopedic trauma surgeon. If the pathology is found in the child, then its treatment must be assigned to the pediatric surgeon. This pathology is very severe and dangerous, but do not despair. Forecasts for those who went through the operation are rather favorable.
Metopic synostosis
A phenomenon in which premature fusion of the frontal bones occurs in the area of the frontal suture. Normally, this seam should not overgrow in children under 2 years old. If the frontal bones fuse before birth or shortly after it, the frontal tubercles cannot develop, a triangular shape appears in the skull (trigonocephaly). Surgical treatment is indicated.