骨科英文书籍精读（111）｜桡尺骨骨折（3）
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Complications
EARLY
Nerve injury
Nerve injuries are rarely caused by the fracture, but they may be caused by the surgeon! Exposure of the radius in its proximal third risks damage to the posterior interosseous nerve where it is covered by the superficial part of the supinator muscle. The proximal fragment of radius may have rotated so the nerve may not be where it is expected. Surgical technique is particularly important here; the anterior Henry approach（见下一篇文章） is safest.
Vascular injury
Injury to the radial or ulnar artery seldom presents any problem, as the collateral circulation is excellent.
Compartment syndrome
Fractures (and operations) of the forearm bones are always associated with swelling of the soft tissues, with the attendant risk of a compartment syndrome. The threat is even greater, and the diagnosis more difficult, if the forearm is wrapped up in plaster. A distal pulse does not exclude compartment syndrome! The byword is ‘watchfulness’; if there are any signs of circulatory embarrassment, treatment must be prompt and uncompromising.
LATE
Delayed union and non-union
Most fractures of the radius and ulna heal within 8–12 weeks; high energy fractures and open fractures are less likely to unite. Delayed union of one or other bone (usually the ulna) is not uncommon; immobilization may have to be continued beyond the usual time. Non-union will require bone grafting and internal fixation.
Malunion
With closed reduction there is always a risk of malunion, resulting in angulation or rotational deformity of the forearm, cross-union of the fragments, or shortening of one of the bones and disruption of the distal radio-ulnar joint. If pronation or supination is severely restricted, and there is no cross-union, mobility may be improved by corrective osteotomy. However, it can be very difficult to calculate the deformity and subsequent correction.
Complications of plate removal
Removal of plates and screws is often regarded as a fairly innocuous procedure. Beware! Complications are common and they include damage to vessels and nerves, infection and fracture through a screw-hole.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
interosseous /,intər'ɔsiəs/adj. 骨间的；小腿骨间的；前臂骨间的
supinator/'sjʊpə,netɚ/n. 旋后肌；走路（或跑步）外八字的人
collateral circulation 侧支循环；侧枝循环；并行循环；
/kəˈlætərəl/adj. 附属的；旁系的；并行的n. 抵押品，担保品；旁系亲属
attendant /əˈtendənt/adj. 伴随的；陪伴的n. 服务员，侍者；随员，陪从；参与者
wrapped up /ræpt ʌp/结束；包起来；全神贯注于 /ræp/vt. 包；缠绕；隐藏；掩护
byword /ˈbaɪwɜːrd/n. 谚语，俗语；格言；笑柄
watchfulness /ˈwɑːtʃflnəs/n. 警觉性
if there are any signs of circulatory embarrassment, treatment must be prompt and uncompromising.如果出现任何循环窘迫的迹象，治疗必须迅速和不妥协。
disruption /dɪsˈrʌpʃn/n. 扰乱，打乱，中断
distal radio-ulnar joint.下尺桡关节
pronation or supination内翻或旋后
restricted /rɪˈstrɪktɪd/v. 限制（restrict的过去式和过去分词）adj. 受限制的；保密的
corrective osteotomy截骨矫正术
百度翻译：
并发症
早期
神经损伤
骨折很少造成神经损伤，但可能是外科医生造成的！桡骨近端三分之一处暴露有损伤骨间后神经的风险，后者被旋后肌浅部覆盖。桡骨近端碎片可能已经旋转，因此神经可能不在预期位置。手术技巧在这里尤为重要；前亨利入路是最安全的。
血管损伤
桡动脉或尺动脉损伤很少出现任何问题，因为侧支循环良好。
间隔室综合征
前臂骨骨折（和手术）总是与软组织肿胀有关，并伴有骨筋膜室综合征的风险。如果前臂被石膏包裹，威胁更大，诊断也更困难。远端脉搏不排除室间隔综合征！代名词是“警惕”；如果有任何循环系统窘迫的迹象，治疗必须迅速和毫不妥协。
晚期
延迟愈合与不愈合
大部分桡骨和尺骨骨折在8-12周内愈合；高能骨折和开放性骨折合并的可能性较小。一块或另一块骨头（通常是尺骨）延迟愈合并不少见；固定可能会超过通常的时间。不愈合需要植骨和内固定。
畸形愈合
闭合复位时，始终存在畸形愈合的风险，导致前臂成角或旋转畸形，碎片交叉愈合，或其中一根骨头缩短，桡尺关节远端断裂。如果旋前或旋后受到严重限制，并且没有交叉愈合，可以通过矫正截骨术改善活动性。然而，计算畸形和随后的矫正是非常困难的。
钢板取出术并发症
去除钢板和螺钉通常被认为是一个相当无害的过程。当心！常见的并发症包括螺丝孔和神经损伤。