骨科英文书籍精读（339）｜胫骨平台骨折的治疗（2）
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Type 3 fractures
The principles of treatment are similar to those applying to type 2 fractures. However, the fact that the lateral rim of the condyle is intact means that the knee is usually stable and a satisfactory outcome is more predictable. The depressed fragments may need to be elevated through a window in the metaphysis; reduction should be checked by x-ray or arthroscopy. The elevated fragments are supported with bone grafts and the whole segment is fixed in position with 'raft’ screws. Postoperatively, exercises are begun as soon as possible and the patient is allowed up in a cast-brace, which is retained until the fracture has united.
Type 4 fracture of the medial condyle
Osteoporotic crush fractures of the medial plateau are difficult to reduce; in the long term the patient is likely to be left with some degree of varus deformity. The principles of treatment are the same as for type 2 fractures of the lateral plateau.
Medial condylar split fractures usually occur in younger people and are caused by high-energy trauma. The fracture itself is often more complex than is appreciated at first sight; there may be a second, posterior split in the coronal plane that cannot be fixed through the standard anterior approach. Good lateral x-rays or CT are needed to define the fracture pattern. There is often an underlying ligament injury on the lateral side. Stable fixation of the medial side, along the lines described for the type 2 fracture will then allow an assessment of the ligament injury. If the joint is unstable after fracture fixation, the torn structures on the lateral side may need repair.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
Osteoporotic骨质疏松的
The fracture itself is often more complex than is appreciated at first sight骨折本身往往比初看上去要复杂得多
underlying /ˌʌndərˈlaɪɪŋ/
adj. 潜在的；根本的；在下面的；优先的
有道翻译（仅供参考，建议自己翻译）：
3型骨折
治疗原则与2型骨折相似。然而，事实上，髁状突的外侧缘是完整的，这意味着膝关节通常是稳定的，一个令人满意的结果是更可预测的。凹陷的碎片可能需要通过干骺端的窗口抬高；复位应通过x光或关节镜检查。抬高的碎片用骨移植物支撑，整个节段用“筏”螺钉固定。术后，应尽快开始训练，允许患者使用石膏支架支撑，直到骨折愈合。
4型骨折
内侧平台骨质疏松性粉碎性骨折很难复位，长期来看，患者可能会有一定程度的内翻畸形。治疗原则与外侧平台2型骨折相同。
内髁劈裂骨折通常发生在年轻人，是由高能量创伤引起的。骨折本身往往比第一眼看到的更复杂；冠状面上可能有第二个后裂口，不能通过标准的前入路固定。需要良好的侧位x线或CT来确定骨折类型。外侧韧带常有损伤。沿着2型骨折所描述的线对内侧进行稳定的固定，可以评估韧带损伤。如果骨折固定后关节不稳定，外侧撕裂的结构可能需要修复。