骨科英文书籍精读（118）｜桡骨远端骨折（3）
Outcome
As Colles himself recognized, the outcome of these fractures in an older age group with lower functional demands is usually good, regardless of the cosmetic or the radiographic appearance. Poor outcomes can often be improved by performing a corrective osteotomy. The amount of displacement that can be accepted depends on patient factors such as age, comorbidity, functional demands, handedness, and quality of bone, and treatment factors such as surgical skill and implants available. As a rule, shortening of more than 2 mm at the distal radio-ulnar joint, dorsal tilt of more than 10 degrees and dorsal translation of more than 30 percent are likely to lead to a poor outcome and early correction should be considered. This advice applies to older osteopaenic fractures; in younger patients the tolerances are far less!
Complications
EARLY
Circulatory problems
The circulation in the fingers must be checked; the bandage holding the slab may need to be split or loosened.
Nerve injury
Direct injury is rare, but compression of the median nerve in the carpal tunnel is fairly common. If it occurs soon after injury and the symptoms are mild, they may resolve with release of the dressings and
elevation. If symptoms are severe or persistent, the transverse ligament should be divided.
Reflex sympathetic dystrophy
This condition is probably quite common, but fortunately it seldom progresses to the full-blown picture of Sudeck’s atrophy. There may be swelling and tenderness of the finger joints, a warning not to neglect the daily exercises. In about 5 percent of cases, by the time the plaster is removed the hand is stiff and painful and there are signs of vasomotor instability. X-rays show osteoporosis and there is increased activity on the bone scan.
TFCC injury
TFCC injury is more common than is generally appreciated. As the distal radius displaces dorsally, the TFCC is damaged; the ulnar styloid
fracture which commonly accompanies a Colles’ fracture illustrates the forces which are transmitted to the TFCC, which attaches in part to it.
LATE
Malunion
Malunion is common, either because reduction was not complete or because displacement within the plaster was overlooked. The appearance is ugly, and weakness and loss of rotation may persist. In most cases treatment is not necessary. Where the disability is severe and the patient relatively young, the lower 1.5 cm of the ulna may be excised to restore rotation, and the radial deformity corrected by osteotomy.
Delayed union and non-union
Non-union of the radius is rare, but the ulnar styloid process often joins by fibrous tissue only and remains painful and tender for several months.
Stiffness
Stiffness of the shoulder, elbow and fingers from neglect is a common complication. Stiffness of the wrist may follow prolonged splintage.
Tendon rupture
Rupture of extensor pollicis longus occasionally occurs a few weeks after an apparently trivial undisplaced fracture of the lower radius. The patient should be warned of the possibility and told that operative treatment is available.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
cosmetic /kɑːzˈmetɪk/n. 化妆品；装饰品adj. 美容的；化妆用的
comorbidity /kemɔr'bidəti/n. 疾病，伴随疾病
handedness /ˈhændɪdnəs/n. 左撇子（或右撇子）倾向；不对称
carpal tunnel 腕管
the transverse ligament should be divided.横韧带要分开。
Reflex sympathetic dystrophy 反射交感性营养不良
overlooked. 忽略；不理会；宽恕
trivial /ˈtrɪviəl/adj. 不重要的，琐碎的；琐细的
百度翻译：
结果
正如Colles自己所认识到的那样，对于功能需求较低的老年人来说，这些骨折的结果通常是好的，无论是外观还是影像学表现。较差的结果通常可以通过矫正截骨术得到改善。可接受的移位量取决于患者因素，如年龄、发病率、功能需求、利手习惯和骨质量，以及治疗因素，如手术技巧和可用的植入物。一般来说，桡尺关节远端缩短超过2毫米，背侧倾斜超过10度，背侧平移超过30%都可能导致不良结果，应考虑早期矫正。这条建议适用于老年骨科骨折；在年轻患者中，耐受性要少得多！
早期并发症
循环系统问题
必须检查手指的循环；固定板子的绷带可能需要撕开或松开。
神经损伤
直接损伤是很少见的，但是正中神经在腕管的压迫是相当常见的。如果在受伤后不久发生，症状较轻，可通过释放敷料和
高程。如果症状严重或持续，横韧带应分开。
反射性交感神经营养不良
这种情况可能相当普遍，但幸运的是，它很少发展到全面的画面，苏德克萎缩。手指关节可能有肿胀和压痛，警告不要忽视日常锻炼。在大约5%的病例中，当取下石膏时，手会僵硬和疼痛，并有血管舒缩不稳定的迹象。X光片显示骨质疏松，骨扫描显示活动增强。
TFCC损伤
TFCC损伤比一般认为的更常见。随着桡骨远端背侧移位，TFCC受损；尺骨茎突
通常伴随Colles骨折的骨折说明了传递给TFCC的力，TFCC部分地附着在TFCC上。
晚期并发症
畸形愈合畸形很常见，要么是因为复位不彻底，要么是因为石膏内的移位被忽略了。外观丑陋，虚弱和失去旋转可能持续存在。在大多数情况下，治疗是不必要的。若伤残严重，且患者年龄较轻，可切除尺骨下1.5cm恢复旋转，并通过截骨矫正桡骨畸形。
延迟愈合与不愈合
桡骨不愈合是罕见的，但尺骨茎突常仅由纤维组织连接，数月后仍会疼痛和疼痛。
僵硬
肩、肘和手指的僵硬是一种常见的并发症。手腕僵硬可能伴随着长时间的夹板固定。
肌腱断裂
拇长伸肌断裂偶尔发生在桡骨下段明显轻微的未移位骨折后几周。应该提醒病人有这种可能，并告诉他们手术治疗是可行的。