骨科英文书籍精读（152）｜指骨远端骨折（2）
TREATMENT
The TIP joint should be immobilized in slight hyperextension, using a special mallet-finger splint which fixes the distal joint but leaves the proximal joints free.
For tendinous avulsions (which usually occur painlessly) the splint should be kept in place constantly for 8 weeks and then only at night for another 4 weeks. Even if there has been a delay of 3 or 4 weeks after injury, this prolonged splintage is usually successful.
Bone avulsions are also treated in a splint, but 6 weeks should suffice as bone heals quicker than tendon. Operative treatment is generally avoided, even for large bone fragments, unless there is subluxation. Surgery carries a high complication rate (wound failure, metalwork problems) without evidence that the outcome is improved. However, if there is subluxation then K-wires or small screws are used to fix the fragment in place.
COMPLICATIONS OF MALLET FINGER
Non-union
This is usually painless and treatment is not needed.
Persistent droop
About 85 per cent of mallet fingers recover full extension. If there is a persistent droop this can be treated by tendon repair supported by K-wire fixation of the joint, but the results are often disappointing. The alternative would be joint arthrodesis, best achieved with a buried intramedullary double-pitch screw.
Swan neck deformity
Imbalance of the extensor mechanism can cause this in lax-jointed individuals. A central slip tenotomy is straightforward and can give a very good result.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
mallet /ˈmælɪt/n. 棒，槌棒；木槌；球棍
mallet finger锤状指
Operative treatment is generally avoided, even for large bone fragments, unless there is subluxation.除非发生半脱位，否则一般避免手术治疗，即使是较大的骨碎片。
Surgery carries a high complication rate (wound failure, metalwork problems) without evidence that the outcome is improved. 手术有很高的并发症率(伤口失败，内植物问题)，没有证据表明结果改善。
Persistent droop持久下垂 /druːp/n. 下垂；消沉
arthrodesis关节融合术/ɑ:'θrɔdəsis/
Swan /swɑːn/n. 天鹅vi. 游荡，闲荡
tenotomy /ti'nɔtəmi, tə-/n. 腱切断术；割腱术
straightforward/ˌstreɪtˈfɔːrwərd/adj. 简单的；坦率的；明确的；径直的
百度翻译：
治疗
尖端关节应固定在轻微的超伸，使用一个特殊的锤状指夹板固定远端关节，但使近端关节自由活动。
对于腱性撕脱伤（通常发生无痛），夹板应持续放置8周，然后仅在夜间放置4周。即使受伤后延迟了3或4周，这种延长的夹板固定通常是成功的。
骨撕脱伤也可以用夹板治疗，但6周就足够了，因为骨愈合快于10个月。手术治疗通常是避免的，即使是大的骨碎片，除非有半脱位。手术有很高的并发症发生率（伤口失败，金属加工问题），但没有证据表明结果得到改善。但是，如果出现半脱位，则使用K形钢丝或小螺钉将支架固定到位。
锤状指并发症
不愈合
这通常是无痛的，不需要治疗。持续性下垂约85%的槌状手指恢复完全伸展。如果有持续性下垂，可以通过肌腱修复和K-线固定关节来治疗，但结果往往令人失望。另一种选择是关节设计，最好用埋置式髓内双螺距螺钉。
天鹅颈畸形
伸肌机械角的不平衡会导致关节松弛的个体。中心滑动肌腱切开术是一种简单易行的方法，可以取得很好的效果。