骨科英文书籍精读（76）｜肱骨近端骨折（3）
Treatment
MINIMALLY DISPLACED FRACTURES
These comprise the vast majority. They need no treatment apart from a week or two period of rest with the arm in a sling until the pain subsides, and then gentle passive movements of the shoulder. Once the fracture has united (usually after 6 weeks), active exercises are encouraged; the hand is, of course, actively exercised from the start.
TWO-PART FRACTURES
Surgical neck fractures
The fragments are gently manipulated into alignment and the arm is immobilized in a sling for about four weeks or until the fracture feels stable and the x-ray shows some signs of healing. Elbow and hand exercises are encouraged throughout this period; shoulder exercises are commenced at about four weeks. The results of conservative treatment are generally satisfactory, considering that most of these patients are over 65 and do not demand perfect function. However, if the fracture cannot be reduced closed or if the fracture is very unstable after closed reduction, then fixation is required. Options include percutaneous pins, bone sutures, intramedullary pins with tension band wiring or a locked intramedullary nail. Plate fixation requires a wider exposure and the newer locking plates offer a stable fixation without the need for extensive periosteal stripping.
Greater tuberosity fractures
Fracture of the greater tuberosity is often associated with anterior dislocation and it reduces to a good position when the shoulder is relocated. If it does not reduce, the fragment can be re-attached through a small incision with interosseous sutures or, in young hard bone, cancellous screws.
Anatomical neck fractures
These are very rare. In young patients the fracture should be fixed with a screw. In older patients prosthetic replacement (hemiarthroplasty) is preferable because of the high risk of avascular necrosis of the humeral head.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
These comprise the vast majority. 这些人占了绝大多数。
passive movements 被动运动
active exercises主动运动
commence /kəˈmens/v. 开始；着手；<英>获得学位
percutaneous/ˌpɜːrkjuːˈteɪniəs/adj. 经皮的；经由皮肤的
intramedullary pins髓内钉 /,intrə,me'dʌləri/adj. [解剖] 髓内的
tension band wiring张力带钢丝
extensive periosteal stripping广泛骨膜剥离
interosseous /,intər'ɔsiəs/adj. 骨间的；小腿骨间的；前臂骨间的
cancellous screws松质骨螺钉 /'kænsələs/adj. 多孔的；罗眼状的（等于cancellate）
prosthetic /prɑːsˈθetɪk/adj. 假体的；非朊基的
hemiarthroplasty半关节成形/置换术
avascular necrosis缺血性坏死 /ei'væskjulə/adj. [医] 无血管的
百度翻译：
治疗
最小位移的骨折
这些占绝大多数。他们不需要治疗，除了一周或两段时间的休息，手臂放在吊带上，直到疼痛消退，然后肩膀轻轻被动运动。一旦骨折愈合（通常在6周后），鼓励积极锻炼；当然，手从一开始就积极锻炼。
两部分骨折
外科颈部骨折
轻轻操作碎片对齐，将手臂固定在吊索中约四周或直至骨折感觉稳定并且x射线显示一些愈合迹象。在此期间鼓励肘部和手部锻炼；肩部锻炼在约四周开始。考虑到这些患者大多数超过65岁并且不需要完美的功能，保守治疗的结果通常是令人满意的。但是，如果骨折不能闭合复位，或者闭合复位后骨折非常不稳定，则需要固定。选项包括经皮针，骨缝合线，带有张力带布线的髓内针或锁定的髓内钉。板固定需要更宽的暴露，而较新的锁定板提供稳定的固定，而不需要广泛的骨膜剥离。
大结节性骨折
大结节的骨折通常与前部脱位有关，当肩部重新定位时，骨折会复位到良好的位置。如果它没有复位，碎片可以通过骨间缝合线的小切口重新连接，或者在年轻的硬骨中通过松质骨螺钉重新连接。
解剖颈部骨折
这些非常罕见。在年轻患者中，骨折应用螺钉固定。在老年患者中，由于肱骨头缺血性坏死的高风险，假体置换（半关节成形术）是优选的。