Prevention of orthopedic disorders in preschoolers

Bulgakova Irina Sergeevna

Physical education instructor

Republic of Khakassia, Abakan

MBDOU "TsRR d / s" Ryabinushka "

Correct posture and normal arches of the feet are necessary factors for the full development of a person. In preschool age, the child's posture is just being formed and any violation of the conditions of this formation leads to pathological changes. The child's skeleton is largely composed of cartilaginous tissue, bones are not strong enough, they have little mineral salts. The extensor muscles are not sufficiently developed, therefore the posture in children is unstable, easily disturbed under the influence of improper body position. The main reasons: insufficient physical activity due to overconsolidation of groups, untimely provision of medical care and irregular treatment and prophylactic work, reduced physical activity of children due to the priority of "intellectual" classes.

Posture is the usual position of the child's body. It develops in the process of individual formation on the basis of hereditary factors and under the influence of upbringing. Hereditary factors can lead to similar posture options in parents and children, a predisposition to a certain type of posture disorder. At the same time, the conditions of physical education make it possible not only to form the child's posture corresponding to aesthetic and physiological requirements, but also to correct, create a new version of it.

Diseases such as rickets, hypotrophy, excess fat deposition, as well as unhealthy nutrition, in which the ratio of the main food ingredients - salts, vitamins, and trace elements - is not maintained, can lead to poor posture. The most common orthopedic disorders in preschoolers: curvature of the spine in the form of lateral deviations (scoliosis); excessive deviation of the spine in the thoracic region (kyphosis) and lumbar (lordosis); flat feet and congenital clubfoot.

Flat feet are foot deformities caused by a decrease in arch height, combined with heel pronation and forefoot supination. The foot in preschool age is in the stage of intensive development, its formation is not yet complete, therefore any unfavorable external influences can lead to the occurrence of functional disorders. The foot is the support, the foundation of the body - its violation is necessarily reflected in the formation of the whole organism. A change in the shape of the foot causes not only a decrease in its functional capabilities, but, which is especially important, affects the position of the spine, which negatively affects the function of the latter and, consequently, the posture and general condition of the child.

That is why physical education teachers pay great attention to the formation of correct posture and normal arches of feet. You can solve the problem of children with poor posture and flat feet with the help of exercise therapy. Physiotherapy is widely used in preschool institutions. The leading feature of exercise therapy is the use of physical exercise as a therapeutic agent. The existing techniques for the formation of correct posture are based on two groups of exercises:

Exercises that have a general effect on the body; contribute to the harmonious development of the locomotor system; develop and strengthen all muscle groups.

Exercises aimed at developing the sensations of correct posture, as well as the development and training of various analyzers involved in maintaining correct posture.

At the same time, it is necessary to take into account: to master any movement, including the position of correct posture, it must be repeated many times in various conditions. Therefore, exercises that contribute to the development of sensations of the correct position of the body in space should be considered as the main means of forming correct posture. Movement in any form, adequate to the physiological capabilities of children, always acts as a health-improving factor. Physical exercises are classified according to anatomical characteristics, degree of activity, and the nature of motor actions.

In the treatment of children with diseases of the musculoskeletal system, positive results can be achieved by using exercise equipment and sports equipment in exercise therapy classes (wall bars, exercise bikes, gymnastic sticks, rope, ribbed paths, etc.)

When conducting exercise therapy classes, all existing forms are used: gymnastics, classes, orthopedic minutes, games, dosed walking. In physiotherapy exercises, the following principles are observed:

1.individualization - the dosage of physical exercises depending on the characteristics of the disease and the general condition of the child;

2. consistency and consistency - a certain selection of exercises and the sequence of their application;

3. regularity - classes are held 2 times a week, other forms daily;

4. duration - 25-30 minutes during the academic year;

5. gradualness - the load increases gradually in the course of the training course;

6. cyclicality - exercises alternate with rest and relaxation exercises;

7. taking into account age characteristics - taking into account pathology, the difference in age is not more than a year.

8. Exercise therapy is a polytherapy method of treatment that combines interrelated means: posture treatment, exercise, massage, natural factors of nature, exercise in water.

A varied combination of the noted remedies for exercise therapy contributes to the restoration of disturbed functions and has a healing effect on the entire body, reduces the adverse effects of forced hypokinesia.

In order to create a positive emotional background, exercises should be performed with music (for example, as a musical accompaniment, you can use "Dance of the Little Swans" from PI Tchaikovsky's ballet. "Swan Lake" in a modern version). In addition, it is necessary to use visual aids (various pictures, drawings), as well as riddles, songs, poems that correspond to the plot of the complex. All this will increase the interest and activity of children and, consequently, better performance of the exercises.

Literature:

V.K. Velitchenko "Physical education for weakened children"

G.V. Kashtanova "Therapeutic exercise and massage"

Kozyreva O.V. "Physiotherapy exercises for preschoolers"

Kudryavtseva V.T., Egorov B.B. "Developing pedagogy of health improvement"

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Diseases of the musculoskeletal system in adult urban residents occupy one of the leading places in terms of prevalence, and their social consequences (temporary disability and disability) in severity exceed those in tuberculosis, diseases of the nervous system and sensory organs, diseases of the respiratory and digestive organs. According to official statistics, the prevalence of diseases of the musculoskeletal system in 2008 was 131.3 cases per 1000 adults.

Appeals for diseases of the musculoskeletal system and connective tissue account for 8-10% of all visits to outpatient clinics and up to 30% of the number of visits to surgeons. Special studies carried out by the Russian Research Institute of Traumatology and Orthopedics named after V.I. RR Vredena in several cities of the Russian Federation, showed that the frequency of diseases of the musculoskeletal system is from 102 to 250 cases per 1000 adults. Osteochondrosis and spondylosis, arthrosis deformans, myositis and periarthritis are most common among these diseases (Table 1).

Table 1. Frequency of diseases of the musculoskeletal system depending on gender (per 1000 inhabitants)

Disease	Men	Women	Total
Deforming arthrosis
Osteochondrosis, spondylosis
Periarthritis
Synovitis, bursitis
Tenosynovitis
Diseases of the hand
Heel spurs
Flat feet

Women suffer from diseases of the musculoskeletal system more often than men.

Despite the fact that a number of scientists consider diseases of the musculoskeletal system to be the lot of the elderly, it has been proven that among 20-29-year-olds, 3% suffer from these diseases, by the age of 30-39 the frequency of orthopedic diseases increases 2.5 times, and by In 40-49 years it doubles even more (Table 2).

Table 2. Frequency of orthopedic diseases by age (per 1000 inhabitants)

Disease	Age, years							Average
							70 and older
Deforming arthrosis
Osteochondrosis, spondylosis
Arthritis (including rheumatoid)
Periarthritis
Synovitis, bursitis
Epicondylitis, styloiditis, trochanteritis
Tenosynovitis
Diseases of the hand
Heel spurs
Flat feet

The presented morbidity rates are calculated based on the data of appealability for 3 years. The morbidity detected by medical examinations was 161.6 cases per 1000 residents over 14 years old. Medical examinations revealed a significant number of diseases that did not manifest themselves clinically or for which patients did not seek medical help (flat feet, heel spurs, deforming arthrosis).

Diseases of bones, muscles and joints, registered in polyclinics annually, account for only 36.3% of the true morbidity of the musculoskeletal system.

Among the reasons for temporary disability in the Russian Federation in 2001, the share of diseases of the musculoskeletal system accounted for 11.2%, and the duration of disability is 128.1 days per 100 workers, on average 15.6 days per patient.

The primary access to disability for these diseases is 2.8 per 10,000 workers, and the number of disabled people reaches 10.9 per 10,000 inhabitants. Moreover, more than half (51.4%) of disabled people become completely disabled (I-II disability group).

The majority of patients (96.5%) use outpatient care, the organization of which largely determines the outcome of the disease.

Currently, patients with diseases of the musculoskeletal system turn to doctors of various specialties: surgeons (41.4%), neuropathologists (21.4%), therapists (14.6%) and other specialists. Often, patients with the same disease are treated by different specialists. So, 31.5% of patients with deforming arthrosis are treated by surgeons, 34.9% - by physiotherapists,

18.4% - from neuropathologists, 12.3% - from therapists, and 2.9% - from other specialists. Therefore, the proportion of patients with unspecified diagnoses, under-examined and with incompletely or incorrectly prescribed treatment is quite high. For example, within four years from the moment of contacting the clinic, 96.5% of patients with deforming arthrosis, 31.3% of patients with osteochondrosis and spondylosis, 94.8% of patients with rheumatoid arthritis, 92.1% of patients with flat feet were not examined radiographically. ... Within three years, of the number of patients with deforming arthrosis, only 39.9% received physiotherapy, physical therapy - 19.6%, massage - 1.8%; among patients with osteochondrosis and spondylosis, physical methods of treatment were prescribed only 35.5%, exercise therapy - 16.2%, massage - 7.3% of patients. 0.6% of patients with orthopedic diseases were under dispensary observation.

Some patients with diseases of the organs of movement are treated by doctors of rheumatology and arthrology offices: with rheumatoid arthritis, ankylosing spondylitis, deforming osteoarthritis with damage to large joints. In these offices, it is advisable to concentrate patients with "fresh" diseases, in the presence of an active inflammatory process, in need of non-operative drug treatment. In the future, in the presence or threat of orthopedic consequences (degenerative-dystrophic changes in the musculoskeletal system, joint deformities), it is advisable to refer the patient for further observation to an orthopedic specialist. To organize outpatient orthopedic care for adults in the form of orthopedic offices in polyclinics, it is necessary to have 1.7 doctor's posts per 100,000 adults. If there is a traumatology and orthopedic department in the APU, it is advisable to separate the reception of the orthopedist from the reception of victims with injuries.

The orthopedic office (reception) is a specialized structural unit of the polyclinic for adults, where the following tasks are solved: identification and provision of qualified specialized medical and diagnostic assistance to patients with diseases of the musculoskeletal system; dispensary observation of patients; examination of the ability to work; carrying out preventive treatment; establishing connections and contacts in work with doctors of children's orthopedic offices, rheumatology offices, trauma centers, occupational pathologists, MSEC.

In accordance with the specified tasks, the orthopedic surgeon conducts:

• treatment, medical examination and examination of the working capacity of patients living in the area of ​​operation of the polyclinic;
• consulting assistance to patients with orthopedic diseases and the consequences of injuries of the musculoskeletal system, living in the area of ​​activity of other polyclinics of the region;
• analysis of morbidity, temporary disability and disability from orthopedic diseases;
• development and implementation of measures to improve medical care for adults with orthopedic diseases in the region;
• analysis of the volume and effectiveness of clinical examination of orthopedic patients and the development of measures to improve it;
• introduction into practice of new methods of diagnosis and treatment of patients with diseases of the organs of movement;
• work with doctors of all specialties on the detection, diagnosis and treatment of orthopedic diseases;
• sanitary and educational work among the population on the prevention of orthopedic diseases and their consequences;
• submission of reports on their activities in accordance with the approved forms and within the established time frame.

Patients with the following diseases are subject to treatment in an orthopedic office for adults:

1) diseases of muscles and tendons - tendovaginitis of the hand, fingers, feet; ganglia on the hand and foot: bursitis; synovitis; stenosing ligamentitis, de Quervain's disease; Dupuytren's contracture;

2) diseases of the spine - spondylitis; spondyloarthrosis; deforming spondylosis; ankylosing spondylitis (ankylosing spondylitis); Scheuermann's disease — May;

3) joint diseases - deforming arthrosis, arthritis; periarthritis; orthopedic consequences of rheumatoid arthritis; Goff's disease; chondromatosis of the joints;

4) benign tumors of bones and soft tissues;

5) congenital deformities of the musculoskeletal system;

6) deformation due to diseases of the brain or spinal cord - Little's disease; Friedreich's disease; orthopedic consequences of poliomyelitis;

7) deformation due to a violation of statics - scoliosis, varus and valgus curvature of the limbs; flat feet, heel spurs;

8) the consequences of injuries of the musculoskeletal system - contractures, false joints, non-fused fractures, osteomyelitis.

The doctor of the orthopedic office uses methods of non-surgical treatment in the treatment of patients: blockade, puncture, physiotherapy, exercise therapy, massage, plaster bandages. To carry out surgical interventions, you must have a clean operating room. If it is impossible to select a separate operating room, you can use a clean (planned) operating room of the surgical or trauma department of the polyclinic.

An orthopedist of a polyclinic for adults can carry out, in the order of providing additional services, dispensary observation of patients of the following groups.

Group I - healthy individuals without significant risk factors of a biological and social nature. Supervised by a local therapist or workshop doctor at the place of work. For them, measures are taken to prevent diseases of bones, muscles and joints; promotion of a healthy lifestyle and active recreation.

Group II - practically healthy, but threatened with diseases of the musculoskeletal system (past illnesses, injuries, increased risk of diseases or injuries of an industrial or domestic nature). They need an annual specialized examination by a surgeon or orthopedist, rational employment, consultations on therapeutic nutrition, the use of prosthetic and orthopedic products, etc.

Groups I and II of dispensary registration include 89.1% of adults.

Group III (9.1%) - persons with manifestations of diseases of the musculoskeletal system at the stage of compensation: with temporary disability (no more than once every two years with a duration of disability up to 3 weeks), with the consequences of injuries (after diaphyseal and intra-articular fractures of long bones, fractures of the spine, damage to ligaments and tendons), after completion of treatment. They need systematic supervision of an orthopedist (prescribing metered loads, exercise therapy, massage, physiotherapeutic procedures; monitoring compliance with therapeutic measures in exacerbations), spa treatment, employment.

Group IV (1.1%) - orthopedic patients with a subcompensated course of the disease: slight functional limitations, exacerbations (up to three times a year), temporary disability (annually lasting up to 3-4 weeks), delayed consolidation, purulent, thromboembolic and other complications. They need to extend their treatment, change their place of work, profession or position. Control examinations - 2 times a year.

Group V (0.6%) - patients in the stage of decompensation of an orthopedic disease (a sharp decrease in the functions of the musculoskeletal system, long-term disability, more than three times a year within 1-1 1/2 months for each exacerbation), disability. Control examinations - 3-4 times a year.

Patients of IV and V groups of dispensary registration require the organization of intensive operative and non-operative rehabilitation treatment using the entire arsenal of means and methods of rehabilitation.

A specialist trained in the treatment of injuries and diseases of the musculoskeletal system is appointed to the position of a doctor in an orthopedic office. The orthopedist is subordinate to the head of the department of the polyclinic and the chief orthopedist-traumatologist of the district (city), works in close contact with local therapists, surgeons, rheumatologists, arthrologists, occupational pathologists, pediatric orthopedists, doctors of adolescent offices. The orthopedist is assigned two positions as a nurse. His workload at the reception is 6 people per hour. The duration of the working day is 5 1/2 hours (as a doctor conducting exclusively outpatient appointments).

In the orthopedic office for adults, the following basic documentation is maintained: outpatient medical history, dispensary card (form 30), operation logbook, plaster work log, disability certificate log, KEC log, hospitalization log, disability log, consultation log (for patients living outside the service area of ​​the polyclinic and visiting an orthopedist once for a consultation), a log book for preventive work, a log book for sanitary and educational work.

The chief physician of a polyclinic with an orthopedic office requests the health care committee to provide the polyclinic with an additional 0.5 rate of an exercise therapy methodologist and a masseur, as well as an additional amount of X-ray film.

The orthopedist is given three days a month to carry out organizational, methodological and preventive work in the area. These days, the orthopedist visits children's orthopedic offices, analyzes the morbidity of the organs of movement among workers at industrial enterprises of the region, visits enterprises, works in MSEC to obtain and analyze data on disability from orthopedic diseases.

Analysis of the work of orthopedic offices showed their high efficiency. This was reflected in a decrease in the average duration of temporary disability (compared with this indicator for treatment by surgeons) from 14.5 to 11.3 days (with deforming arthrosis - from 16.9 to 14.5, with periarthritis - from 13.3 to 12.1, with epicondylitis - from 14.6 to 12.5, with stenosing ligamentitis - from 23.9 to 14.8 days). The primary disability rate decreased from 3.9 to 3.5 per 10,000 workers and employees. The quality of diagnostics has improved significantly. Physiofunctional treatment provided 75-80% of patients, 10% of patients were taken under dispensary observation.

Traumatology and Orthopedics. N. V. Kornilov

The number of patients seeking help from an orthopedist is growing every year. It's all to blame for physical inactivity, wearing uncomfortable shoes, long-term work on legs or at the computer. Timely medical assistance helps to stop the development of the disease and prevent complications.

The doctors of the MEDSI clinics have extensive experience in the treatment and prevention of orthopedic diseases and practice an individual approach to each patient.

One of the important components of orthopedic treatment is the use of individual insoles, which allow taking into account the characteristics of each foot and developing the best solution for the prevention and correction of existing deviations. We work with Sursil ortho and FormTotics insoles.

The experience of MEDSI orthopedic traumatologists in the field of foot orthotics allows realizing a truly comprehensive individual approach to leg health for the whole family.

Benefits of customized insoles:

• Accurate reconstruction of the surface and compliance with all individual characteristics of the foot of each patient
• No pain when wearing. At the beginning of using the insoles, especially with pronounced deformation of the foot, discomfort may occur, as well as a feeling of pressure or a foreign body, increased fatigue in the legs. This is a normal adaptation period and lasts no more than 2 weeks. This occurs as a result of the redistribution of the load not only in the foot, but also in the joints (ankle, knee, hip) and the spine
• The possibility of correcting the insoles during use (taking into account the patient's gait and wear of the insoles themselves)
• Thickness - the insoles are very thin, so they can be used when wearing any shoe, including dress shoes
• Using natural materials for making insoles
• No deformation even with prolonged wear

When are custom insoles prescribed?

Individual orthopedic insoles are required for:

• Transverse, longitudinal and combined flat feet
• Varicose veins
• Joint pain
• Long-term work on legs
• Diabetic foot
• Hallux valgus
• Heel spur
• Spine diseases
• For leg pain in pregnant women
• Arthritis
• Gout

Prevention, clinical examination and organization of early detection, and therapy of orthopedic diseases

Timely application of preventive measures is of great importance for the successful treatment of physical defects.

With congenital developmental anomalies, orthopedic prophylaxis is literally impossible, since children have already been born with them.

However, in childhood, under the influence of stress and rapid bone growth, deformities increase. In this regard, at present, orthopedic prophylaxis for congenital deformities consists in the timely diagnosis and treatment of pathology. Subsequently, the study of the etiology and pathogenesis of congenital diseases of the musculoskeletal system will prevent the development of pathology during pregnancy of the mother. A successful solution to the problem can be achieved with the joint work of embryologists, biochemists, geneticists, obstetricians and orthopedists.

Prevention of deformities resulting from the severity of childbirth is carried out by improving the technique of obstetrics, the use of a cesarean section, timely diagnosis of difficult labor, etc. Prevention of umbilical sepsis and hematogenous osteomyelitis in newborns is important. Orthopedic prophylaxis is most successfully used to prevent secondary deformities developing due to various diseases. For our preventive measures to really be beneficial, you need to know the function of joints and muscles that governs their movements. For example, when in case of poliomyelitis the function of certain muscles falls out on the basis of paralysis, then by the localization of the paralysis it is possible to determine what kind of deformation will form in the future; extensor paralysis of the foot leads to the development of the equine foot. With paralysis of the gastrocnemius muscle, a heel foot is formed. In these cases, plaster splints should be applied in reverse positions; keep the limb in the position of slight hypercorrection.

Early and timely treatment of deformities of the musculoskeletal system in children is the key to the success of the restoration of the affected organs.

Deviations in the development of ODA in young children are easier to correct, and anatomical and functional recovery is faster and more complete than with neglected deformities with large, often irreversible anatomical changes in older children. Therefore, early diagnosis, staging, continuity in treatment and dispensary observation are necessary conditions for obtaining successful results of specialized care for children.

Children with early forms of orthopedic diseases receive the main care in outpatient clinics. The main tasks of organizing outpatient care for children with orthopedic diseases are: carrying out preventive measures, organizing early detection and early treatment, clinical examination, implementation of continuity during staged treatment, etc. maternity hospital, in the children's clinic by neonatologists, neuropathologists, orthopedists and surgeons. The examination is carried out 1-2 days after the birth of the child. At the same time, children from the risk group, with an unfavorable history, after difficult childbirth, breech presentation, born in asphyxia or with other signs of birth trauma, premature babies should be carefully examined by all specialists. All children, both with identified or suspected disorders of the structure and development of the musculoskeletal system, and from the risk group, are placed in the polyclinic at the place of residence for dispensary registration and are subject to repeated examinations. All children at the age of 2-3 months must undergo a repeated preventive examination by an orthopedist.

At this age, fixed deformities remain pronounced, and the pathological settings of the trunk, head and limbs, due to the intrauterine position, disappear. Subsequently, all children in kindergartens, nurseries and schools undergo preventive examinations once a year. All children with identified pathology of the musculoskeletal system are taken for dispensary registration in the polyclinic. Children with the following diseases of the musculoskeletal system are subject to dispensary observation: congenital torticollis, clubfoot, congenital dislocation of the hip, congenital underdevelopment and limb defects, scoliosis, the consequences of poliomyelitis, spastic paralysis, the consequences of trauma, tumors, etc.

Thus, the main measures for clinical examination are as follows:

1. Active patient identification

2. Taking on dispensary registration

3. Timely implementation of a complex of medical and social preventive measures.

Through clinical examination, in practice, the unity of preventive and curative work is carried out.

V.L. Andrianov, N.G. Mirzoeva (1988) recommend the following scheme of dispensary observation of children with congenital and acquired diseases.

After a certain period of treatment on an outpatient basis, children with untreated diseases and deformities of the musculoskeletal system are sent for inpatient treatment to specialized trauma and orthopedic departments. Specialized orthopedic care for children is provided in the traumatology and orthopedic departments of city and regional hospitals, in the clinics of medical advanced training institutes, as well as in the Research Institute of Orthopedics.

Shamik Viktor Borisovich

Shamik Viktor Borisovich, Professor Department of Pediatric Surgery and Orthopedics, Rostov State Medical University, Doctor of Medical Sciences, Member of the Dissertation Council of Rostov Medical University with a degree in Pediatric Surgery, Member of the Academic Council of the Pediatric Faculty, Pediatric Traumatologist-Orthopedist of the highest qualification category

Appointment to a specialist

Vinnikov Sergey Vladimirovich

Vinnikov Sergey Vladimirovich, Pediatric traumatologist-orthopedist of the traumatology and orthopedic department for children of the polyclinic MBUZ "City Hospital No. 20" of the city of Rostov-on-Don

Appointment to a specialist

Fomenko Maxim Vladimirovich

Fomenko Maxim Vladimirovich Candidate of Medical Sciences. Head of the Department of Traumatology and Orthopedics for Children, Candidate of Medical Sciences, Pediatric Traumatologist-Orthopedist of the Highest Category

Appointment to a specialist

Lukash Yulia Valentinovna

Lukash Yulia Valentinovna Candidate of Medical Sciences, Traumatologist-Orthopedist, Associate Professor of the Department of Pediatric Surgery and Orthopedics

Appointment to a specialist

Page editor: Oksana Kryuchkova

The great role of prevention in the development, course and outcomes of various diseases and deformation of the musculoskeletal system has been known since the time of Hippocrates and Galen. However, it was Andri who first definitely spoke about its role in the fight against deformities in children in 1741, titling his book - "Orthopedics or the art of preventing and correcting deformities of the body in children." Describing in this essay the origin, clinical course and treatment of distorted body shapes in children, Andri pays most attention to preventive measures. Founders of foreign and domestic orthopedics: Adams, Bnzalsky, Goffa, Lorenz. Sayre, Haglund, R.R. Vreden, G.I.Turner, M.I.Sntenko and others (Adams, Biesalski, Hoffa, Lorenz, Sayre, Haglund) have repeatedly pointed out that in many pathological processes of the organs of support and movement in children treatment often consists of only one orthopedic prophylaxis. And adheres to a similar direction. modern scientific orthopedics, especially Soviet scientific orthopedics.

Preventive measures, as is known, constitute the main content of the work of Soviet health care. The program adopted by the XXII Congress of the CPSU says: “The socialist state is the only state that takes care of protecting and constantly improving the health of the entire population. This is ensured by a system of socio-economic and medical measures. A broad program will be carried out aimed at preventing and decisively reducing diseases, eliminating massive infectious diseases, and further increasing life expectancy "

Currently, it can be safely argued that prevention is of paramount importance in the fight against childhood disability.

In contrast to the prevention of orthopedic diseases in children in capitalist countries, where it is for the most part interpreted as individual prevention, with the goal of preventing illness and the occurrence of malnutrition in individual children, in the USSR this prevention, in the broad sense of the word, is a whole system of preventive and health-improving measures. aimed at protecting and strengthening the health and physical development of the entire child population of the country. In the complex of these measures, a significant place is taken by measures to improve the nutrition and living conditions of children, the struggle to reduce childhood morbidity and injuries, early detection and specialized treatment. NN Priorov pointed out that Soviet medical science developed the main method of Soviet health care - a method of prevention, which has become universal both in the implementation of the broadest preventive measures and in the use of highly improved methods of treating diseases. He emphasizes that the preventive direction of Soviet health care in combination with its organizational principles - district service to the population using the dispensary method - created all the conditions for the prevention of injuries, deformities and diseases of the musculoskeletal system in children.

Preventive measures in orthopedics are as varied as the etiological factors of various types of child impairment. In the postwar years, special methods have been developed for the prevention of various diseases and deformities of the musculoskeletal system and posture defects in children of preschool and school age with the widespread use of therapeutic exercises and massage and the use of orthopedic devices and products that prevent the development of deformations. In recent years, special attention has been paid to the prevention of congenital and paralytic deformities and the prevention of scoliosis.

An analysis of the data obtained in the study (1952, 1953 and 1954) of children in need of orthopedic care (NN Priorov), shows that congenital deformities are approximately 34.0%, the consequences of poliomyelitis - 30.0%; spastic paralysis - 8.0%; static deformations - 9.0%; tuberculous and other infectious deformities - 9.0%, the consequences of trauma - 5.0% and the consequences of systemic, dystrophic and other diseases - 5.0%. Thus, about 2/3 of all children in need of orthopedic care suffer from congenital or paralytic deformities. Scoliosis has a significantly lower proportion among other deformities in children.

The etiology and pathogenesis of many congenital defects and deformities have not yet been fully studied and orthopedic prevention of their occurrence, therefore, is still unlikely. However, most congenital deformities (with the exception of ectromelia) are in early childhood (breastfeeding) only minor deviations from the norm, which only over time, under the influence of growth and function in pathological conditions, turn into severe deformities with impaired function. So, for example, congenital subluxation of the hip, mild forms of clubfoot, torticollis and others do not represent true deformities in the first months of a child's life, both in the nature of the existing morphological changes, and in the relative ease of their correction. In such cases, prevention is quite possible, consisting in early correction of the deformity (abduction of the limbs "in case of dislocation and subluxation of the hips, straightening the foot with clubfoot, abduction of the head in the opposite direction in case of crankshaft) and fixation in the corrected position, that is, therapeutic orthopedic prophylaxis that relieves the development of deformity and dysfunction and contributing to the return of the child to the path of normal development.

A huge role in the prevention of the development of childhood feces due to diseases of the nervous system belongs to the mass immunization of the population carried out in the USSR with the live attenuated Seibin vaccine. As a result of immunization, the incidence of poliomyelitis has dropped sharply. The clinical picture of its course has also completely changed (mild spinal and aparalytic forms prevail), and, therefore, there are significantly fewer children with severe paralytic deformities.

Orthopedic prophylaxis also plays a very important role here. Various types of contractures that arise in children in the acute and recovery periods in the future quickly entail a change in the shape of the bones and their interposition, especially with continued load. Thus, contractures turn into a similar type of deformation. Prevention of deformities in poliomyelitis, therefore, primarily consists of prevention; contractures, which should be started at the very beginning of the recovery stage. Prevention of the formation of contractures at this stage is achieved by appropriate placement of the child and the use of plaster and plastic splints in combination with physiotherapy procedures, and further - by supplying rational orthopedic products. These preventive measures prevent the development of imbalance between the muscles and at the same time contribute to the restoration of those of them that are in a state of paresis.

A significant number of children who have had poliomyelitis have deformities of the limbs of the spine; arising in connection with a static load during the loss of the function of individual muscles and stretching of the ligamentous-ligamentous apparatus (valgus deformities and recurvation of the knee joint, rotation of the lower leg, planovalgus deformity of the foot, subluxation of the hip joint, scoliosis, etc.). Here, too, early orthopedic prophylaxis plays a large role (Therapeutic gymnastics, correct laying of the body using plaster beds and rods, dosed loading of the lower extremities and their stabilization with orthopedic products, education of a child's walking stereotype, etc.). In order to prevent thickening of the calcaneus with paralysis of the triceps muscle and descent and dislocation of the shoulder with paralysis of the deltoid muscle, they have found use in the recovery period of the course of the disease and surgery (Lange, Camera - Camera, M.S. Zhukhovitsky, 1961) of a preventive nature, i.e. active prevention - philodesy, theiodesy

Orthopedic prophylaxis for deformities caused by spastic paralysis of both cranial and spinal origin is comparatively less effective.

In children, paraplegic deformities of cranial origin (Little's disease) are most often observed as a result of trauma to the vessels of the pia mater and brain during pathological childbirth: premature birth, a narrow pelvis, childbirth in asphyxia, prolapse of the umbilical cord, forceps, etc. General prevention of the development of these deformities is quite possible. It consists in improving the technique of obstetrics and in the more frequent use of Caesar section in difficult pathological childbirth. Orthopedic prevention here is expressed only in the timely identification of such children and the early use of gymnastics using plaster and plastic spikes in order to prevent the development of severe contractures and deformities.

Orthopedic prevention also plays an important role in deformities resulting from trauma, osteoarticular tuberculosis, infectious arthritis, rickets, etc. in children, it often completely protects against the onset and development of deformities, and with the end of the process, the function is restored. In severe clinical course, the advancing deformities and ankylosis of the joints are functionally more beneficial. The lack of orthopedic prophylaxis, as a rule, entails the development of severe curvatures, pathological dislocations or ankylosis in a vicious position that are difficult to correct.

The systematic development and implementation of measures to prevent injuries among children is of essential importance in the prevention of child malnutrition.

This work is carried out by the joint efforts of medical, party, Soviet and public organizations and includes, along with organizing children's leisure time, improving traffic regulation, extensive health education work among all segments of the population, measures to improve the quality of specialized care for injured children.

The main types of child injuries - household, street, school, sports - have a different distribution in different age groups, as a result of which the tasks of preventive measures for children of each age group will be unique. Thus, according to the data of N.M. Obodan and G. Ya. Epstein, in infants, in 88% of accidents, there were domestic injuries, and burns predominated among them (35%). In school-age children, all types of Injuries are found, however, in this group, the largest specific dog belongs to street injuries (37%), including traffic injuries.

Combating traffic injuries due to the large growth of vehicles requires daily efforts, which are fully justified. So, in particular in Leningrad, where, along with state bodies (traffic police, health departments, education), the general public (parents, house committees, teachers, etc.) has been involved in prevention, in recent years, it has been possible to achieve a decrease in traffic injuries among children in 4 -Five times.