骨科英文书籍精读（283）｜股骨干骨折晚期并发症之再发骨折
我们正在精读国外经典骨科书籍《Apley’s System of Orthopaedics and Fractures》，想要对于骨科英文形成系统认识，为以后无障碍阅读英文文献打下基础，请持续关注。
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Refracture and implant failure
Fractures which heal with abundant callus are unlikely to recur. By contrast, in those treated by internal fixation, callus formation is often slow and meagre. With delayed union or non-union, the integrity of the femur may be almost wholly dependent on the implant and sooner or later it will fail. If a comminuted fracture is plated, bone grafts should be added and weightbearing delayed so as to protect the plate from reaching its fatigue limit too soon. Intramedullary nails are less prone to break.
However, sometimes they do, especially with a slowhealing fracture of the lower third and a static locked nail; the break usually occurs through the screw-hole closest to the fracture. Treatment consists of replacing the nail and adding bone grafts. In resistant cases, the fracture site may need excising (as viability of the bone ends is poor) followed by distraction osteogenesis which simultaneously stabilizes the limb and deals with the length discrepancy (Figure 29.30).
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
meagre /ˈmiːɡər/adj. 瘦的；贫弱的；贫乏的
With delayed union or non-union, the integrity of the femur may be almost wholly dependent on the implant and sooner or later it will fail. 对于延迟愈合或不愈合，股骨的完整性可能几乎完全依赖于髓内钉，迟早会失败。
the integrity of the femur 股骨的完整
integrity /ɪnˈteɡrəti/n. 完整；正直；诚实；廉正
fatigue limit 疲劳极限；疲劳限界
fatigue /fəˈtiːɡ/n. 疲劳，疲乏；杂役adj. 疲劳的
be less prone to break更不容易破裂
distraction osteogenesis牵拉骨生成技术（骨搬运）
simultaneously /ˌsaɪmlˈteɪniəsli/adv. 同时地
spontaneous /spɑːnˈteɪniəs/ adj. 自发的；自然的；无意识的
discrepancy /dɪˈskrepənsi/n. 不符；矛盾；相差
百度翻译：
再骨折与植入失败
骨折愈合后有大量骨痂不太可能复发。相比之下，在那些内固定治疗，骨痂形成往往是缓慢和微薄的。延迟愈合或不愈合时，股骨的完整性几乎完全依赖于植入物，迟早会失败。如果是粉碎性骨折，应加植骨并延迟负重，以防止钢板过早达到疲劳极限。髓内钉不易折断。
然而，有时也会这样，尤其是下三分之一处骨折愈合缓慢，使用静态锁定钉时；骨折通常通过离骨折最近的螺钉孔发生。治疗包括更换指甲和增加骨移植。在有阻力的情况下，骨折部位可能需要切除（因为骨端的生存能力很差），然后进行牵张成骨，同时稳定肢体并处理长度差异（图29.30）。