骨科英文书籍精读（105）｜肱骨远端骨骺分离

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FRACTURE-SEPARATION OF THE DISTAL HUMERAL PHYSIS

Up to the age of 7 years the distal humeral epiphysis is a solid cartilaginous segment with maturing centres of ossification. With severe injury it may separate en bloc. This is likely to occur with fairly severe violence; for example, in birth injuries or child abuse.

Clinical features

The child is in pain and the elbow is markedly swollen. The history may be deceptively uninformative.

X-ray 

In a very young child, in whom the bony outlines are still unformed, the x-ray may look normal. All that can be seen of the epiphysis is the pea-like ossification centre of the capitulum; its position should be compared with that of the normal side. Medial displacement of either the capitellar ossification centre or the proximal radius and ulna is very suspicious. In the older child the deformity is usually obvious.

Treatment

If the diagnosis is uncertain, arthrography or ultrasound can help. If the fracture is undisplaced, the elbow is merely splinted for 3 weeks; if displaced then the fracture should be accurately reduced and held with smooth percutaneous wires (otherwise there is a high incidence of cubitus varus). The wires are removed at 3 weeks.

---from 《Apley’s System of Orthopaedics and Fractures》

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重点词汇整理：

maturing centres of ossification成熟的骨化中心

en bloc/ɔŋ'blɔk/全体；总体而言

deceptively/dɪˈseptɪvli/adv. 看似；不像看上去那么；比实际更显得

epiphysis /i'pifisis/n. 骺；脑上体；松果体

physis /'faisis/n. 自然界生长原则；后缀生长

ossification centre骨化中心

suspicious /səˈspɪʃəs/adj. 可疑的；怀疑的；多疑的

ultrasound /ˈʌltrəsaʊnd/n. 超声；超音波

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百度翻译：

肱骨远端骨骺分离

7岁以下肱骨远端骨骺是一个坚实的软骨节段，骨化中心逐渐成熟。严重损伤时可整体分离。这种情况很可能发生在相当严重的暴力事件中；例如，产伤或虐待儿童。

临床特征

孩子疼，肘部明显肿胀。这段历史可能令人难以置信地缺乏信息。

X射线

在一个很小的孩子，骨性轮廓还未成形，x光片可能看起来很正常。骨骺可见的是小头豆状骨化中心，其位置应与正常侧比较。小头骨化中心或桡骨尺骨近端的内侧移位是非常可疑的。大一点的孩子畸形通常很明显。

治疗

如果诊断不确定，关节造影或超声波可以帮助。如果骨折不移位，肘关节仅用夹板固定3周；如果移位，则应精确复位并用光滑的经皮克氏针固定（否则肘内翻的发生率很高）。3周后拆除克氏针。

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