骨科英文书籍精读（96）｜儿童肘关节周围骨折（1）
FRACTURES AROUND THE ELBOW IN CHILDREN
The elbow is second only to the distal forearm for frequency of fractures in children. Most of these injuries are supracondylar fractures, the remainder being divided between condylar, epicondylar and proximal radial and ulnar fractures. Boys are injured more often than girls and more than half the patients are under 10 years old.
The usual accident is a fall directly on the point of the elbow or – more often – onto the outstretched hand with the elbow forced into valgus or varus. Pain and swelling are often marked and examination is difficult. X-ray interpretation also has its problems: The bone ends are largely cartilaginous and therefore radiographically incompletely visualized. A good knowledge of the normal anatomy is essential if fracture displacements are to be recognized.
Points of anatomy
The elbow is a complex hinge, providing sufficient mobility to permit the upper limb to reach through wide ranges of flexion, extension and rotation, yet also enough stability to support the necessary gripping, pushing, pulling and carrying activities of daily life. Its stability is due largely to the shape and fit of the bones that make up the joint – especially the humero-ulnar component – and this is liable to be compromised by any break in the articulating structures. The surrounding soft-tissue structures also are important, especially the capsular and collateral ligaments and, to a lesser extent, the muscles. Ligament disruption is also, therefore, a destabilizing factor.
The forearm is normally in slight valgus in relation to the upper arm, the average carrying angle in children being about 15 degrees. (Published measurements range from 5 to 25 degrees). When the elbow is flexed, the forearm comes to lie directly upon the upper arm. Doubts about the normality of these features can usually be resolved by comparing the injured with the normal arm.
With the elbow flexed, the tips of the medial and lateral epicondyles and the olecranon prominence form an isosceles triangle; with the elbow extended, they lie transversely in line with each other.
Though all the epiphyses are in some part cartilaginous, the secondary ossific centres can be seen on x-ray; they should not be mistaken for fracture fragments! The average ages at which the ossific centres appear are easily remembered by the mnemonic CRITOE: Capitulum – 2 years. Radial head – 4 years. Internal (medial) epicondyle – 6 years. Trochlea – 8 years. Olecranon – 10 years. External (lateral) epicondyle – 12 years. Obviously epiphyseal displacements will not be detectable on x-ray before these ages. Fracture displacement and accuracy of reduction can be inferred from radiographic indices such as Baumann’s angle (see Fig. 24.30).
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
The bone ends are largely cartilaginous and therefore radiographically incompletely visualized. 骨端大部分为软骨，因此x线摄影显示不完全。
A good knowledge of掌握……的知识;l对……得很好了解
hinge/hɪndʒ/n. 铰链，折叶；关键，转折点
grip /ɡrɪp/n. 紧握；柄；支配；握拍方式；拍柄绷带vt. 紧握；夹紧vi. 抓住
to a lesser extent,在较小程度上
carrying angle 提携角 外偏角
isosceles triangle等腰三角形 /aɪ'sɑsə'liz/adj. 二等边的，[数] 等腰的
the secondary ossific centres 次级骨化中心
epiphyses 骨骺
they should not be mistaken for fracture fragments它们不应该被误认为是骨折碎片
mnemonic /nɪˈmɑːnɪk/adj. 记忆的；助记的；记忆术的
Capitulum – 2 years. Radial head – 4 years. Internal (medial) epicondyle – 6 years. Trochlea – 8 years. Olecranon – 10 years. External (lateral) epicondyle – 12 years.
肱骨小头——2岁。桡骨小头——4年。内（内侧）上髁-6岁。滑车——8年。鹰嘴——10年。外（侧）上髁-12岁。
百度翻译：
儿童肘关节周围骨折
在儿童中，肘部骨折的发生率仅次于前臂远端。这些损伤大多为髁上骨折，其余分为髁状突骨折、上髁骨折和桡尺骨近端骨折。男孩比女孩更容易受伤，一半以上的病人年龄在10岁以下。
通常的意外情况是直接摔倒在肘部，或者更多的情况下，摔倒在伸直的手上，肘部被迫伸入外翻或内翻。疼痛和肿胀通常很明显，检查很困难。X射线的解释也有它的问题：骨头的末端大部分是软骨组织，因此在放射学上不能完全显示出来。如果要识别骨折移位，良好的正常解剖学知识是必不可少的。
解剖学要点
肘关节是一个复杂的铰链，提供了足够的活动性，使上肢能够通过大范围的屈曲、伸展和旋转来活动，同时还具有足够的稳定性，以支持日常生活中必要的抓握、推、拉和搬运活动。它的稳定性很大程度上取决于构成关节的骨骼的形状和适合性，尤其是肱尺骨部分，关节结构的任何断裂都可能损害到这一点。周围的软组织结构也很重要，尤其是囊膜和副韧带，以及肌肉。因此，韧带断裂也是一个不稳定因素。
前臂通常与上臂有轻微外翻，儿童的平均背角约为15度。（公布的测量范围为5至25度）。当肘部弯曲时，前臂直接躺在上臂上。对这些特征是否正常的怀疑通常可以通过比较受伤者和正常手臂来解决。
当肘部弯曲时，内外上髁的尖端和鹰嘴突起形成等腰三角形；当肘部伸直时，它们横向排列成一条直线。
虽然所有的骨骺部分是软骨性的，但在x光片上可以看到次级骨化中心，不要误认为是骨折碎片！骨化中心出现的平均年龄很容易被记忆标准：小头——2岁记住。桡骨头——4年。内（内侧）上髁-6岁。滑车——8年。鹰嘴龙——10年。外（侧）上髁-12岁。显然，在这些年龄之前，在x光片上看不到骨骺移位。断裂位移和复位精度可根据射线照相指标如鲍曼角推断（见图24.30）。