骨科英文书籍精读（147）｜第一掌骨基底骨折
Bennett’s fracture-dislocation
This fracture, too, occurs at the base of the first metacarpal bone and is commonly due to punching; however the fracture is oblique, extends into the CMC joint and is unstable.
The thumb looks short and the carpo-metacarpal region swollen. X-rays show that a small triangular fragment has remained in contact with the medial edge of the trapezium, while the remainder of the thumb has subluxated proximally, pulled upon by the abductor pollicis longus tendon.
Treatment
It is widely supposed (with little evidence) that perfect reduction is essential. It should, however, be attempted and can usually be achieved by pulling on the thumb, abducting it and extending it. Reduction can then be held in one of two ways: plaster or internal fixation.
Plaster may be applied with a felt pad over the fracture, and the first metacarpal held abducted and extended (usually best achieved by flexing the MCP joint). However, plaster only works if it is applied with great skill, and the pressure required to maintain a reduction can cause skin damage; it has, therefore, generally been abandoned in favour of surgery.
Surgical fixation is achieved by passing a K-wire across the metacarpal base into the carpus. If the fragment is large and cannot be reduced and held with a wire, then open reduction and fixation with a lag screw is effective.
ROLANDO’S FRACTURE
This is an intra-articular comminuted fracture of the base of the first metacarpal with a T or Y configuration. Closed reduction and K-wiring or open reduction and plate fixation can be used. With more severe comminution, external fixation is needed.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
trapezium /trəˈpiːziəm/n. 大多角骨
remainder /rɪˈmeɪndər/n. [数] 余数，残余；剩余物；其余的人adj. 剩余的；吃剩的
abductor pollicis longus tendon拇长展肌腱
felt pad 毛毡坐垫；棉垫；毛毡垫板
felt /felt/n. 毡，毛毡；毡制品
it has, therefore, generally been abandoned in favour of surgery.因此，手术已普遍代替石膏固定。
in favour of 支持，赞成
intra-articular comminuted fracture关节内粉碎性骨折
configuration /kənˌfɪɡjəˈreɪʃn/n. 配置；结构；外形
百度翻译：
贝内特骨折脱位
这种骨折也发生在第一掌骨的底部，通常是由于打孔造成的；但是骨折是倾斜的，延伸到CMC关节并且不稳定。
拇指短，腕掌区肿胀。X光片显示，一个小的三角形碎片仍与梯形的内侧边缘接触，而拇指的其余部分在拇长展肌肌腱的牵引下近端半脱位。
治疗
人们普遍认为（几乎没有证据）完全还原是必要的。但是，应该尝试，通常可以通过拉拇指、外展拇指和伸展拇指来实现。复位可采用两种方法之一：石膏或内固定。
石膏可以用毛毡垫敷在骨折处，第一掌骨外展并伸展（通常最好通过弯曲MCP关节来实现）。然而，膏药只有在运用技巧高超的情况下才能发挥作用，而维持减量所需的压力会导致皮肤损伤；因此，一般情况下，为了手术而放弃了石膏。
手术固定是通过一根K-线穿过掌骨基底进入腕关节来实现的。如果碎片较大，不能用钢丝固定，则切开复位并用拉力螺钉固定是有效的。
罗兰多骨折
第一掌骨基底关节内粉碎性骨折，呈T形或Y形。可采用闭合复位K-接线或开放复位钢板固定。粉碎程度越重，需要外固定。