骨科英文书籍精读（112）｜单侧桡骨或尺骨骨折
FRACTURE OF A SINGLE FOREARM BONE
Fracture of the radius alone is very rare and fracture of the ulna alone is uncommon. These injuries are usually caused by a direct blow – the ‘nightstick fracture’. They are important for two reasons:
· An associated dislocation may be undiagnosed; if only one forearm bone is broken along its shaft and there is displacement, then either the proximal or the distal radio-ulnar joint must be dislocated. The entire forearm, elbow and wrist should always be x-rayed.
· Non-union is liable to occur unless it is realized that one bone takes just as long to consolidate as two.
Clinical features
Ulnar fractures are easily missed – even on x-ray. If there is local tenderness, a further x-ray a week or two later is wise.
X-ray
The fracture may be anywhere in the radius or ulna. The fracture line is transverse and displacement is slight. In children, the intact bone sometimes bends without actually breaking (‘plastic deformation’).
Treatment
Isolated fracture of the ulna
The fracture is rarely displaced; a forearm brace leaving the elbow free can be sufficient. However, it takes about 8 weeks before full activity can be resumed. Rigid internal fixation will allow earlier activity and avoids the risk of displacement or non-union.
Isolated fracture of the radius
Radius fractures are prone to rotary displacement; to achieve reduction in children the forearm needs to be supinated for upper third fractures, neutral for middle third fractures and pronated for lower third fractures. The position is sometimes difficult to hold in children and just about impossible in adults; if so, then internal fixation with a compression plate and screws in adults, and preferably intramedullary rods in children, is better.
Middle/distal third fractures of the radius in children
These are particularly unstable, being deformed by the pull of the thumb abductors and pronator quadratus. They can be treated with an above-elbow cast in supination but, failing that, fixation with an intramedullary rod, Kirschner (K-) wires or a plate is advisable.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
nightstick/ˈnaɪtstɪk/n. 看更人或警察的木棒；警棍
consolidate /kənˈsɑːlɪdeɪt/vt. 巩固，使固定；联合vi. 巩固，加强
slight /slaɪt/n. 怠慢；轻蔑adj. 轻微的，少量的；脆弱的；细长的；不重要的vt. 轻视，忽略；怠慢
Isolated /ˈaɪsəleɪtɪd/adj. 偏远的；孤立的；孤独的；单独的；绝缘的v. 使……孤立；使……分离；将……剔出（isolate 的过去式和过去分词）
brace /breɪs/v. 使做准备；抵住；绷紧；支撑；加固n. 夹子；支架
resume /rɪˈzuːm/vt. （中断后）重新开始，继续
Radius fractures are prone to rotary displacement;桡骨骨折易发生旋转位移; prone to有…倾向的 /proʊn/adj. 俯卧的；有…倾向的，易于…的
deform /dɪˈfɔːrm/adj. 畸形的；丑陋的vi. 变形；变畸形vt. 使变形；使成畸形
百度翻译：
单前臂骨折
单纯桡骨骨折很少见，尺骨骨折也不常见。这些伤害通常是由直接打击造成的，即“夜棍骨折”。它们之所以重要有两个原因：
·一个相关的脱位可能无法诊断；如果只有一个前臂骨沿着其轴断裂并发生移位，那么近端或远端桡尺关节必须脱位。整个前臂、肘部和手腕都应该进行x光检查。
·除非意识到一块骨头和两块骨头一样长，否则很容易发生骨不连。
临床特征
尺骨骨折很容易漏诊，即使是在x光片上。如果有局部压痛，一两周后再做一次x光检查是明智的。
X射线
骨折可能在桡骨或尺骨的任何地方。断裂线是横向的，位移很小。在儿童身上，完整的骨头有时会弯曲而没有真正断裂（“塑性变形”）。
治疗
尺骨孤立性骨折
骨折很少移位；前臂支具使肘部自由活动就足够了。然而，大约需要8周的时间才能恢复全部活动。坚固的内固定将允许早期活动，避免移位或不愈合的风险。
桡骨孤立性骨折
桡骨骨折容易发生旋转移位；为了使儿童复位，上三分之一骨折需要旋入前臂，中三分之一骨折需要旋前，下三分之一骨折需要旋前。这种姿势在儿童中有时很难固定，在成人则几乎不可能；如果是这样的话，成人用加压钢板和螺钉内固定，儿童最好是髓内棒固定。
儿童桡骨中远段第三骨折
这些是特别不稳定的，被拇指外展肌和旋前方肌拉变形。可以在旋后位时用肘上石膏固定，但如果不能，则建议使用髓内棒、克氏针或钢板固定。