骨科英文书籍精读（106）｜桡骨颈骨折
FRACTURED NECK OF RADIUS
Mechanism of injury and pathology
A fall on the outstretched hand forces the elbow into valgus and pushes the radial head against the capitulum. In children the bone fractures through the neck of the radius; in adults the injury is more likely to fracture the radial head.
Clinical features
Following a fall, the child complains of pain in the elbow. There may be localized tenderness over the radial head and pain on rotating the forearm.
X-ray
The fracture line is transverse. It is either situated immediately distal to the physis or there is true separation of the epiphysis with a triangular fragment of shaft (a Salter-Harris II injury). The proximal fragment is tilted distally, forwards and outwards. Sometimes the upper end of the ulna is also fractured or there may be a posterior dislocation of the elbow.
Treatment
In children there is considerable potential for remodelling after these fractures. Up to 30 degrees of radial head tilt and up to 3 mm of transverse displacement are acceptable. The arm is rested in a collar and cuff, and exercises are commenced after a week.
Displacement of more than 30 degrees requires reduction. With the patient’s elbow extended, traction and varus force are applied; the surgeon then pushes the displaced radial fragment into position with his thumb. If this fails, a percutaneous implement can be used to push the fragment back into place. Open reduction is occasionally performed if significant displacement persists. The radial head tilt is corrected but internal fixation is unnecessarily meddlesome. The head of the radius must never be excised in children because this will interfere with the synchronous growth of radius and ulna.
Fractures that are seen a week or longer after injury should be left untreated (except for light splintage).
Following operation, the elbow is splinted in 90 degrees of flexion for a week or two and then movements are encouraged.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
distal/ˈdɪstl/adj. [解剖] 末梢的，末端的
forwards and outwards.向前,向外。
commence /kəˈmens/v. 开始；着手；<英>获得学位
persist /pərˈsɪst/vi. 存留，坚持；持续，固执vt. 坚持说，反复说
meddlesome /ˈmedlsəm/
adj. 爱管闲事的；好干涉的
excise /ˈeksaɪz; ɪkˈsaɪz/v. 切除；删除；收税，征税n. 消费税，货物税
exercise/ˈeksərsaɪz/n. 运动；练习；
synchronous growth同步生长/ˈsɪŋkrənəs/adj. 同步的；同时的
百度翻译：
桡骨颈骨折
损伤机制与病理
伸直的手摔倒会迫使肘部进入外翻，并将桡骨头推向小头。儿童桡骨颈部骨折；成人更容易骨折桡骨头部。
临床特征
摔了一跤，孩子抱怨肘部疼痛。桡骨头上可能有局部压痛和前臂旋转时疼痛。
X射线
断裂线是横向的。它要么直接位于身体的远端，要么是真正的骨骺分离与一个三角形的骨干碎片（一个Salter-Harris II损伤）。近端的碎片向远端、向前和向外倾斜。有时尺骨上端也会骨折或肘关节后脱位。
治疗
儿童骨折后有相当大的重塑潜力。可接受最大30度的径向头部倾斜和不超过3 mm的横向位移。手臂放在衣领和袖口上，一周后开始运动。
位移超过30度需要减小。随着病人肘关节的伸展，牵引力和内翻力被施加；外科医生然后用拇指将移位的桡骨碎片推到位。如果失败，可以使用经皮穿刺的工具将碎片推回到原位。如果持续出现明显位移，偶尔进行开放复位。桡骨头倾斜得到纠正，但内固定是不必要的干预。儿童的桡骨头部绝对不能切除，因为这样会妨碍桡骨和尺骨的同步生长。
受伤后一周或更长时间出现的骨折应不进行治疗（轻微夹板固定除外）。
术后，肘关节用夹板固定成90度的屈曲，持续一到两周，然后鼓励活动。