骨科英文书籍精读（85）｜肱骨远端骨折（2）
TYPE A – SUPRACONDYLAR FRACTURES
These extra-articular fractures are rare in adults. When they do occur, they are usually displaced and unstable – probably because there is no tough periosteum to tether the fragments. In high-energy injuries there may be comminution of the distal humerus.
Treatment
Closed reduction is unlikely to be stable and K-wire fixation is not strong enough to permit early mobilization. Open reduction and internal fixation is therefore the treatment of choice. The distal humerus is approached through a posterior exposure. It is sometimes possible to fix the fracture without recourse to an olecranon osteotomy or triceps reflection. A simple transverse or oblique fracture can usually be reduced and fixed with a pair of contoured plates and screws.
TYPES B AND C – INTRA-ARTICULAR FRACTURES
Except in osteoporotic individuals, intra-articular condylar fractures should be regarded as high-energy injuries with soft-tissue damage. A severe blow on the point of the elbow drives the olecranon process upwards, splitting the condyles apart. Swelling is considerable, but if the bony landmarks can be felt the elbow is found to be distorted. The patient should be carefully examined for evidence of vascular or nerve injury; if there are signs of vascular insufficiency, this
must be addressed as a matter of urgency.
X-Ray
The fracture extends from the lower humerus into the elbow joint; it may be difficult to tell whether one or both condyles are involved, especially with an undisplaced condylar fracture. There is often also comminution of the bone between the condyles, the extent of which is usually underestimated. Sometimes the fracture extends into the metaphysis as a T- or Y shaped break, or else there may be multiple fragments (comminution). The lesson is: ‘Prepare for the worst before operating’. CT scans can be helpful in planning the surgical approach.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
tether美 /ˈteðər/n. 系链；拴绳v. （用绳或链）拴住
olecranon osteotomy 尺骨鹰嘴截骨
/o'lɛkrənɑn/n. [解剖] 鹰嘴（肘部的骨性隆起）
/,ɑstɪ'ɑtəmi/n. 截骨术，骨切开术
triceps reflection肱三头肌反转
contoured /ˈkɑːntʊrd/adj. 波状外形的
osteoporotic骨质疏松的；骨质疏松症
distorted /dɪs'tɔrtɪd/v. 扭曲（distort的过去式和过去分词）adj. 歪曲的；受到曲解的
vascular insufficiency血管功能不全
urgency. /ˈɜːrdʒənsi/n. 紧急；催促；紧急的事
extend /ɪkˈstend/vt. 延伸；扩大；推广；伸出；给予；使竭尽全力；对…估价
extent /ɪkˈstent/n. 程度；范围；长度
metaphysis /mətefəsis/n. [医] 干骺端；干骨后端
百度翻译：
A型-髁上骨折
这些关节外骨折在成人中很少见。当它们确实发生时，它们通常会移位并且不稳定-可能是因为没有坚韧的骨膜来系住碎片。在高能量损伤中，肱骨远端可能会粉碎。
治疗
闭合复位不太可能稳定，K线固定不够强，无法尽早动员。因此，切开复位和内固定是首选治疗方法。通过后部暴露接近肱骨远端。有时可以在不依赖鹰嘴截骨术或肱三头肌反射的情况下固定骨折。通常可以减少简单的横向或倾斜断裂并用一对轮廓板和螺钉固定。
B型和C型-关节内骨折
除骨质疏松症患者外，关节内750髁突骨折应视为软组织损伤的高能量损伤。肘部严重受伤会推动鹰嘴过程向上，将髁分开。肿胀是相当可观的，但如果可以感觉到骨性标志，则发现肘部变形。应仔细检查患者血管或神经损伤的证据；如果有血管功能不全的迹象，则
必须紧急处理。
X射线
骨折从肱骨下部延伸到肘关节；可能很难判断是否涉及一个或两个髁，特别是对于未移位的髁突骨折。髁突之间通常还会有骨头粉碎，其程度通常被低估。有时骨折作为T形或变形断裂延伸到干骺端，否则可能有多个碎片（粉碎）。教训是：“在操作前做好最糟糕的准备”。CT扫描有助于规划手术方法。