骨科英文书籍精读（120）｜儿童前臂远端骨折（1）
DISTAL FOREARM FRACTURES IN CHILDREN
The distal radius and ulna are among the commonest sites of childhood fractures. The break may occur through the distal radial physis or in the metaphysis of one or both bones. Metaphyseal fractures are often incomplete or greenstick.
Mechanism of injury
The usual injury is a fall on the outstretched hand with the wrist in extension; the distal fragment is forced posteriorly (this is often called a ‘juvenile Colles’ fracture’). However, sometimes the wrist is in flexion and the fracture is angulated anteriorly. Lesser force may do no more than buckle the metaphyseal cortex (a type of compression fracture, or torus fracture).
Clinical features
There is usually a history of a fall, though this may be passed off as one of many childhood spills. The wrist is painful, and often quite swollen; sometimes there is an obvious ‘dinner-fork’ deformity.
X-ray
The precise diagnosis is made on the x-ray appearances. Physeal fractures are almost invariably Salter–Harris type I or II, with the epiphysis shifted and tilted backwards and radially. Type V injuries are unusual; sometimes they are diagnosed in retrospect when premature epiphyseal fusion occurs.
Metaphyseal injuries may appear as mere buckling of the cortex (easily missed unless appropriate views are obtained), as angulated greenstick fractures or as complete fractures with displacement and shortening. If only the radius is fractured, the ulna may be bent though not fractured.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
juvenile /ˈdʒuːvənl/n. 青少年；少年读物adj. 青少年的；幼稚的
buckle /ˈbʌkl/n. 带扣，搭钩；（尤指鞋的）扣形饰物v. 扣住，用搭扣装饰；屈服，退让；使弯曲变形；（人）精神崩溃
cortex /ˈkɔːrteks/n. [解剖] 皮质；树皮；果皮
torus美 /ˈtɔːrəs/n. [植] 花托；圆环面；[解剖] 隆凸
though this may be passed off as one of many childhood spills. 尽管这可能被误认为是童年时期的一次意外。
precise /prɪˈsaɪs/adj. 精确的；明确的；严格的
invariably /ɪnˈveriəbli/adv. 总是；不变地；一定地
radially /'reidiəli/adv. 放射状地
premature /ˌpriːməˈtʃʊr,ˌpriːməˈtʊr/n. 早产儿；过早发生的事物adj. 早产的；不成熟的；比预期早的
mere /mɪr/n. 小湖；池塘adj. 仅仅的；只不过的
百度翻译：
儿童前臂远端骨折
桡骨远端和尺骨是儿童骨折最常见的部位。骨折可能发生在桡骨远端或一侧或两侧的干骺端。干骺端骨折通常是不完整的或绿色的。
损伤机制
常见的损伤是手腕伸直时摔倒在伸直的手上；远端骨折片被压在后方（这通常被称为“青少年Colles骨折”）。然而，有时腕关节屈曲，骨折向前成角。较小的力只会使干骺端皮质屈曲（一种压缩性骨折或环状骨折）。
临床特征
通常有跌倒的历史，尽管这可能被当作童年时期的一次失足而被忽略掉。手腕疼痛，经常肿胀；有时会有明显的“餐叉”畸形。
X射线
根据x线表现作出准确诊断。Physeal骨折几乎总是更严重——HarrisⅠ型或Ⅱ型，骨骺移位并向后倾斜，呈放射状。V型损伤是不常见的；有时当骨骺过早融合时，回顾性诊断。
干骺端损伤可表现为单纯的皮质屈曲（除非获得适当的视野，否则很容易被忽略）、成角的绿枝骨折或伴有移位和缩短的完全性骨折。如果只有桡骨骨折，尺骨可能会弯曲，虽然没有骨折。