骨科英文书籍精读（110）｜桡尺骨骨折（2）
ADULTS
Unless the fragments are in close apposition, reduction is difficult and re-displacement in the cast almost invariable. So predictable is this outcome that most surgeons opt for open reduction and internal fixation from the outset. The fragments are held by interfragmentary compression with plates and screws. Bone grafting is
advisable if there is comminution. The deep fascia is left open to prevent a build-up of pressure in the muscle compartments, and only the skin is sutured.
After the operation the arm is kept elevated until the swelling subsides, and during this period active exercises of the hand are encouraged. If the fracture is not comminuted and the patient is reliable, early range of movement exercises are commenced but lifting and sports are avoided. It takes 8–12 weeks for the bones to unite. With comminuted fractures or unreliable patients, immobilization in plaster is safer.
OPEN FRACTURES
Open fractures of the forearm must be managed meticulously. Antibiotics and tetanus prophylaxis are given as soon as possible; the wounds are copiously washed and nerve function and circulation are checked. At operation the wounds are excised and extended and the bone ends are exposed and thoroughly cleaned. The fractures are primarily fixed with compression screws and plates; if the wounds are absolutely clean, the soft tissues can be closed. If bone grafting is necessary, this is best deferred until the wounds are healed. If there is major soft-tissue loss, the bones are better stabilized by external fixation.The aim is to obtain skin cover as soon as possible; if plastic surgery services are available, these should be enlisted from the outset.
If there is any question of a compartment syndrome, the wounds should be left open and closed 24–48 hours later, with a skin graft if needed.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
from the outset从一开始
fascia /ˈfeɪʃə/n. 招牌；[医] 筋膜；绷带；饰带
subside/səbˈsaɪd/vi. 平息；减弱；沉淀；坐下
meticulously /məˈtɪkjələsli/adv. 细致地；一丝不苟地；拘泥地
tetanus prophylaxis破伤风预防
/ˈtetnəs/n. [内科] 破伤风；强直
/ˌproʊfəˈlæksɪs/n. [医] 预防；预防法
copiously/'kəupiəsli/adv. 充裕地；丰富地
defer /dɪˈfɜːr/vt. 使推迟；使延期vi. 推迟；延期；服从
百度翻译：
成人
除非碎片紧密地并置，否则很难还原，铸件中的再置换几乎是可变的。这种结果是可以预见的，大多数sur geons从一开始就选择切开复位和内固定。这些碎片是用钢板和螺丝钉通过膈间压缩来固定的。骨移植是
如果有粉碎，建议使用。深筋膜是开放的，以防止压力积聚在肌肉室，只有皮肤是缝合。
手术后手臂保持抬高直到肿胀消退，在此期间鼓励手部的积极锻炼。如果骨折不粉碎且患者可靠，则应尽早进行运动训练，但应避免提举和运动。骨头需要8-12周才能愈合。对于粉碎性骨折或无法愈合的患者，石膏固定更安全。
开放性骨折
前臂开放性骨折必须精心处理。尽快给予抗生素和破伤风预防，充分清洗伤口，检查神经功能和循环。在手术中，伤口被切除并延伸，骨端暴露并彻底清洁。骨折主要用加压螺钉和钢板固定；如果伤口绝对干净，软组织可以闭合。如果需要植骨，最好推迟到伤口愈合。如果有大面积的软组织丢失，骨骼可以更好地通过外部来稳定固定。那个目的是尽快获得皮肤覆盖；如果整形外科服务可用，则从一开始就应该争取这些服务。
如果有任何室间综合征的问题，伤口应在24-48小时后开放闭合，必要时进行植皮。