骨科英文书籍精读（352）｜胫腓骨骨折的术后处理
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Postoperative management
Swelling is common after tibial fractures; even after skeletal fixation the soft tissues continue to swell for several days. The limb should be elevated and frequent checks made for signs of compartment syndrome (see later).
After intramedullary nailing of a transverse or short oblique fracture, weightbearing can be started within a few days and increased to full weight when this is comfortable. If the fracture is comminuted or segmental, meaning that almost the entire load will be taken by the nail initially, only partial weightbearing is permitted until some callus is seen on x-ray.
With plate fixation, additional support with a cast may be needed if partial weightbearing is to start soon after surgery; otherwise weightbearing is delayed for 6 weeks. Unlike fractures treated with intramedullary nails, callus formation is not seen as rapidly and this may give a poor signal for increasing the amount of weightbearing.
Patients with fractures stabilized with external fixators can usually weightbear early unless there is major bone loss. Weightbearing through the fractured tibia is increased when callus is visible on x-ray; the fixator is later 'dynamized’ to allow greater load transfer through the bone and help the callus bridge to mature. This does away with the need for exchanging the external fixator for a functional brace. However, if the pin sites are in poor condition or there is loosening of the hold on the tibia, a change to functional bracing is helpful.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
the fixator is later 'dynamized’ to allow greater load transfer through the bone and help the callus bridge to mature.胫骨髓内钉随后需要动力化（取出远端螺钉），以允许更大的负荷通过骨折端，并帮助骨痂桥成熟。
This does away with the need for exchanging the external fixator for a functional brace.这样就不需要将外固定架换成功能性支架。
有道翻译（仅供参考，建议自己翻译）：
术后处理
胫骨骨折后肿胀是很常见的；即使在骨固定后，软组织也会持续肿胀好几天。肢体应抬高，并经常检查是否有骨筋膜室综合征的迹象（见下文）。
横形或短斜形骨折髓内钉固定后，几天内可开始负重，在舒适的情况下可增加至全重。如果骨折是粉碎性的或节段性的，这意味着最初几乎全部的载荷将由钉子承担，只有部分负重是允许的，直到x光片上看到一些骨痂。
对于钢板固定，如果术后很快开始部分负重，可能需要额外的石膏支撑；否则负重延迟6周。与髓内钉治疗骨折不同，骨痂的形成并不迅速，这可能是增加负重量的不良信号。
使用外固定器固定的骨折患者通常可以早期负重，除非有严重的骨丢失。当骨痂在x光片上可见时，通过骨折胫骨的负重增加；固定器随后被“激活”，以允许更大的载荷通过骨转移，并帮助骨痂桥接成熟。这样就不用把外固定器换成功能性支架了。然而，如果销钉位置状况不佳或胫骨固定松动，则更换功能性支撑是有帮助的。