骨科英文书籍精读（359）｜腓骨骨折和疲劳骨折
我们正在精读国外经典骨科书籍《Apley’s System of Orthopaedics and Fractures》，想要对于骨科英文形成系统认识，为以后无障碍阅读英文文献打下基础，请持续关注。
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FRACTURE OF FIBULA ALONE
Isolated spiral fractures should be regarded with suspicion: they are often associated with other injuries and it is wise to obtain x-rays of the ankle and knee.
A transverse or short oblique fracture may be due to a direct blow. There is local tenderness, but the patient is able to stand and to move the knee and ankle. Pain can usually be controlled by analgesic medication and the patient will need no more than an elastic bandage, from knee to toes, for 2 or 3 weeks. In the occasional case where pain is more severe, a below-knee walking cast may be necessary.
Pathological fractures sometimes occur in patients with osteomyelitis or bone tumours. Treatment is that of the underlying condition.
FATIGUE FRACTURES
Repetitive stress may cause a fatigue fracture of the tibia (usually in the upper half of the bone) or the fibula (most often in the lower third). This injury is seen in army recruits, mountaineers, runners and ballet dancers, who complain of pain in the leg. There is local tenderness and slight swelling. The condition may be mistaken for a chronic compartment syndrome.
X-ray
For the first 4 weeks there may be nothing abnormal about the x-ray, but a bone scan shows increased activity. After some weeks periosteal new bone may be seen, with a small transverse defect in the cortex.
There is a danger that these appearances may be mistaken for those of an osteosarcoma, with tragic consequences. If the diagnosis of stress fracture is kept in mind, such mistakes are unlikely.
Treatment
The patient is told to avoid the stressful activity. Usually after 8–10 weeks the symptoms settle down. A short leg gaiter can be applied for comfort during weightbearing
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
analgesic medication 镇痛药物
/ˌænəlˈdʒiːzɪk/adj. （药剂）镇痛的
elastic bandage弹性绷带；橡胶绷带
osteomyelitis /ˌɒstɪoʊˌmaɪəˈlaɪtɪs/n. [外科] 骨髓炎
recruits/rɪˈkruːts/n. 新兵；新成员（recruit的复数形式）；幼鱼v. 征募；雇佣；恢复健康（recruit的三单形式）
The condition may be mistaken for a chronic compartment syndrome.这种情况可能被误认为慢性筋膜室综合征。
increased activity活性增强
osteosarcoma/,ɑstiosɑr'komə/n. [肿瘤] 骨肉瘤
with tragic consequences.悲剧性的结局
tragic /ˈtrædʒɪk/adj. 悲剧的；悲痛的，不幸的
gaiter /ˈɡeɪtər/n. 绑腿；长筒橡胶靴
有道翻译（仅供参考，建议自己翻译）：
单纯腓骨骨折
孤立性螺旋形骨折应视为单纯性骨折：螺旋形骨折常伴有其他损伤，最好是对踝关节和膝关节进行x线检查。
横断或短斜骨折可能是由于直接打击所致。局部有压痛，但患者能够站立并移动膝盖和脚踝。疼痛通常可以通过止痛药来控制，病人从膝盖到脚趾只需要弹性绷带，持续2到3周。在偶尔疼痛更严重的情况下，膝下行走石膏可能是必要的。
病理性骨折有时发生在骨髓炎或骨肿瘤患者。治疗是对基础疾病的治疗。
疲劳骨折
重复的应力可能会导致胫骨（通常在上半截骨）或腓骨（通常在下半截骨）疲劳性骨折。这种损伤见于新兵、登山运动员、跑步者和芭蕾舞演员，他们抱怨腿部疼痛。局部压痛，轻度肿胀。这种情况可能被误认为是慢性室间隔综合征。
X射线
在最初的4周里，x光片可能没有异常，但骨骼扫描显示活动增加。几周后可以看到骨膜新骨，皮质有小的横向缺损。
有一种危险，这些现象可能会被误认为是骨肉瘤，与悲惨的后果。如果牢记应力性骨折的诊断，这样的错误是不可能的。
治疗
病人被告知要避免紧张的活动。通常在8-10周后，症状就会稳定下来。一个短腿绑腿可以适用于舒适的举重