骨科英文书籍精读（75）｜肱骨近端骨折（2）
Clinical features
Because the fracture is often firmly impacted, pain may not be severe. However, the appearance of a large bruise on the upper part of the arm is suspicious. Signs of axillary nerve or brachial plexus injury should be sought.
X-ray
In elderly patients there often appears to be a single, impacted fracture extending across the surgical neck. However, with good x-rays, several undisplaced fragments may be seen. In younger patients, the fragments are usually more clearly separated. Axillary and scapular-lateral views should always be obtained, to exclude dislocation of the shoulder.
It has always been difficult to apply Neer’s classification when based on plain x-rays and not surprisingly there is a relatively high level of both inter- and intraobserver disagreement. Neer himself later noted that when this classification was developed the criteria for displacement (distance >1cm, angulation >45 degrees) were set arbitrarily. The classification was not intended to dictate treatment, but simply to help clarify the pathoanatomy of the different fracture patterns.
The advent of three-dimensional CT reconstruction has helped to reduce the degree of inter- and intra-observer error, enabling better planning of treatment than in the past.
As the fracture heals, the humeral head is sometimes seen to be subluxated downwards (inferiorly); this is due to muscle atony and it usually recovers once exercises are begun.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
bruise /bruːz/n. 擦伤；挫伤；青肿
vt. 使受瘀伤；使受挫伤vi. 擦伤；受伤
suspicious /səˈspɪʃəs/adj. 可疑的；怀疑的；多疑的
the surgical neck外科颈
criteria /kraɪ'tɪrɪə/n. 标准，条件（criterion 的复数）
The classification was not intended to dictate treatment, but simply to help clarify the pathoanatomy of the different fracture patterns.分类并不是为了指导治疗，而是为了帮助阐明不同骨折类型的病理解剖。
pathoanatomy病理解剖学
atony /'ætəni/n. [医] 弛缓，无力；（尤指收缩器官的）[医] 张力缺乏；迟缓；无重音
百度翻译：
临床特征
因为骨折通常是牢固的撞击，疼痛可能并不严重。不过，手臂上部出现大面积瘀伤令人怀疑。应寻找腋神经或臂丛神经损伤的迹象。
X射线
在老年患者中，常有一个单一的、嵌顿性骨折延伸到手术颈部。然而，在良好的x射线下，可以看到一些未扩散的碎片。在年轻患者中，碎片通常分离得更清楚。应始终获得腋侧和肩胛侧位，以排除肩关节脱位。
基于普通x射线的Neer分类一直很难应用，而且观察者之间和观察者内部的分歧也相对较高。Neer自己后来指出，当这一分类被开发时，位移的标准（距离>1cm，角度>45度）是任意设定的。分类并不是为了指导治疗，而是为了帮助阐明不同骨折类型的病理解剖。
三维CT重建技术的出现有助于减少观察者之间和观察者内部误差的程度，使治疗计划比过去更好。
骨折愈合时，肱骨头有时向下半脱位（自卑）；这是由于肌肉松弛所致，一旦开始运动，肱骨头通常会恢复。