骨科英文书籍精读（233）｜股骨颈骨折X线表现
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X-ray
Two questions must be answered: is there a fracture, and is it displaced? Usually the break is obvious, but an impacted fracture can be missed by the unwary. Displacement is judged by the abnormal shape of the bone outlines and the degree of mismatch of the trabecular lines in the femoral head and neck and the supra-acetabular (innominate) part of the pelvis (Figure 29.5). This assessment is important because impacted or undisplaced fractures do well after internal fixation, whereas displaced fractures have a high rate of non-union and avascular necrosis.
In Garden I fractures the femoral head is in its normal position or tilted into valgus and impacted on the femoral neck stump. The medial cortex may be intact. The femoral head stress trabeculae are normally aligned with the innominate trabeculae.
In Garden II fractures the femoral head is normally placed and the fracture line may be difficult to discern.
In Garden III fractures the anteroposterior x-ray shows that the femoral head is tilted out of position and the trabecular markings are not in line with those of the innominate bone; this is because the proximal fragment retains some contact with the neck stump and is pushed out of alignment.
In Garden IV fractures the femoral head trabeculae are normally aligned with those of the innominate bone; the reason is that the proximal fragment has lost contact with the femoral neck and lies in its normal position in the acetabular socket.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
unwary /ʌnˈweri/adj. 粗心的；不警惕的；不谨慎的
trabecular lines骨小梁走行线
/trə'bekjulə/adj. 小梁的；有小带的；有横隔片的
stump /stʌmp/vt. 砍伐；使为难；在…作巡回政治演说n. 树桩；残余部分；假肢
The medial cortex may be intact.内侧皮质可能完好无损。
align/əˈlaɪn/
vt. 使结盟；使成一行；匹配
vi. 排列；排成一行
innominate /ɪˈnɑːmənɪt/adj. 无名的；匿名的
discern /dɪˈsɜːrn/vt. 觉察出；识别；了解；隐约看见
be in line with
be aligned with
百度翻译：
X射线
必须回答两个问题：是否有骨折，是否移位？通常断裂很明显，但是粗心的人会漏掉撞击性骨折。移位的判断依据是骨骼轮廓的异常形状以及股骨头和颈部以及骨盆的髋臼上（无名）部分的斜线不匹配的程度（图29.5）。这个评估很重要，因为嵌顿或未移位的骨折在椎体间固定后表现良好，而移位骨折有很高的不愈合率和缺血性坏死。
在Garden I骨折中，股骨头处于正常位置或倾斜成外翻并撞击股骨颈残端。内侧皮质可能是完整的。股骨头应力小梁通常与无名小梁对齐。
Garden II型骨折股骨头位置正常，骨折线可能难以辨认。
在Garden III型骨折中，前后位x光片显示股骨头倾斜错位，骨小梁标记与无名骨不一致；这是因为近端碎片与颈部残端保持一定的接触，并被推开。
Garden IV型骨折的股骨头小梁通常与无名骨的骨小梁对齐；原因是近端骨碎片与股骨颈失去接触，位于髋臼窝的正常位置。