骨科英文书籍精读（102）｜肱骨外髁骨折（3）
Treatment
If there is no displacement the arm can be splinted in a backslab with the elbow flexed 90 degrees, the forearm neutral and the wrist extended (this position relaxes the extensor mechanism which attaches to the fragment). However, it is essential to repeat the x-ray after 5 days to make sure that the fracture has not displaced. The splint is removed after 2 weeks and exercises are encouraged.
A displaced fracture requires accurate reduction and internal fixation. If the fragment is only moderately displaced (hinged), it may be possible to manipulate it into position by extending the elbow and pressing upon the condyle, and then fixing the fragment with percutaneous pins. If this fails, and for all separated fractures, open reduction and internal fixation with pins is required. The arm is immobilized in a cast; cast and pins are removed after 3 or 4 weeks.
Complications
Non-union and malunion
If the condyle is left capsized, non-union is inevitable; with growth the elbow becomes increasingly valgus, and ulnar nerve palsy is then likely to develop. Stiffness and pain can result.
Even minor displacements sometimes lead to nonunion, and even slight malunion may lead to ulnar palsy in later life; it is for these reasons that open reduction (and internal fixation) is preferred for any displaced fracture. The fracture is a Salter Harris Type IV injury and so imperfect reduction can result in growth arrest. Even if a fracture presents late (e.g. up to 3 months) open reduction and fixation should be attempted.
Recurrent dislocation
Occasionally condylar displacement results in posterolateral dislocation of the elbow. The only effective treatment is reconstruction of the bony and soft tissues on the lateral side.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
hinge /hɪndʒ/n. 铰链，折叶；关键，转折点；枢要，中枢v. 用铰链连接；依…为转移；给…安装铰链；（门等）装有蝶铰
valgus /vælɡəs/n. 外翻足的人；外翻足adj. 外翻的
palsy /ˈpɔːlzi/n. 麻痹，麻痹状态；中风vt. 麻痹；使瘫痪
百度翻译：
治疗
如果没有移位，手臂可以用夹板固定在背部，肘部弯曲90度，前臂保持中立，手腕伸展（这个位置放松附着在碎片上的伸肌机构）。然而，5天后必须重复x光检查，以确保骨折没有移位。夹板2周后取出，并鼓励锻炼。
移位的骨折需要精确的复位和内固定。如果碎片只是中度移位（铰链连接），则可以通过伸展肘关节并按压髁突，然后用经皮穿刺针固定碎片，将其固定到位。如果失败，并且所有分离骨折，则需要切开复位并用销钉内固定。手臂固定在石膏里；石膏和别针在3到4周后被移除。
并发症
不愈合和畸形愈合
如果髁突左侧倾覆，不愈合是不可避免的；随着生长，肘关节变得越来越外翻，尺神经麻痹很可能发展。可能导致僵硬和疼痛。
即使是轻微的移位有时也会导致骨不连，即使是轻微的畸形愈合也会在以后的生活中导致尺神经麻痹；正是由于这些原因，对于任何移位的骨折，开放复位（和内固定）是首选。骨折属于Salter-HarrisⅣ型损伤，复位不彻底可能导致生长停滞。即使骨折出现较晚（如长达3个月），也应尝试切开复位和固定。
复发性脱位
偶尔髁突移位导致肘关节后外侧脱位。唯一有效的治疗方法是重建侧骨和软组织。