骨科英文书籍精读（131）｜腕舟骨骨折（3）
Treatment
Fracture of the scaphoid tubercle needs no splintage and should be treated as a wrist sprain; a crepe bandage is applied and movement is encouraged. Other scaphoid fractures are treated as follows.
Undisplaced fractures need no reduction and are treated in plaster; 90 per cent of waist fractures should heal. The cast is applied from the upper forearm to just short of the metacarpo-phalangeal joints of the fingers, but incorporating the proximal phalanx of the thumb. The wrist is held dorsiflexed and the thumb forwards in the ‘glass-holding’ position. The plaster must be carefully moulded into the hollow of the
hand, and is not split. It is retained (and if necessary repaired or renewed) for 8 weeks.
After 8 weeks the plaster is removed and the wrist examined clinically and radiologically. If there is no tenderness and the x-ray shows signs of healing, the wrist is left free; a CT scan is the most reliable means of confirming union if in doubt.
If the scaphoid is tender, or the fracture still visible on x-ray, the cast is reapplied for a further 4 weeks. At that stage, one of two pictures may emerge: (a) the wrist is painless and the fracture has healed – the cast can be discarded; (b)the x-ray shows signs of delayed healing (bone resorption and cavitation around the fracture) – union can be hastened by bone grafting and internal fixation.
Displaced fractures can also be treated in plaster, but the outcome is less predictable. It is better to reduce the fracture openly and to fix it with a compression screw. This should increase the likelihood of union and reduce the time of immobilization.
Some patients may not want to endure a prolonged period in plaster. Early percutaneous fixation with a compression screw, though technically demanding, can dramatically reduce the time away from work and the difficulties associated with personal care.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
tubercle /ˈtuːbərkl/n. （皮肤、骨头或植物上的）结节，疣粒，小块茎；（肺）结核结节
crepe /kreɪp/n. 绉纱；绉绸
metacarpo-phalangeal掌指的，掌骨和指骨的
incorporate /ɪnˈkɔːrpəreɪt/vt. 包含，吸收；体现；把……合并adj. 合并的；一体化的；组成公司的vi. 合并；混合；组成公司
corporate/ˈkɔːrpərət/adj. 法人的；共同的，全体的；社团的；公司的；企业的
corporation /ˌkɔːrpəˈreɪʃn/n. 公司；法人（团体）；社团；市政当局
phalanx /ˈfeɪlæŋks/n. 趾骨，指骨；方阵；密集队形
dorsiflexed 背伸位
hollow /ˈhɑːloʊ/n. 洞；山谷；窟窿adj. 空的；中空的，空腹的；凹的；虚伪的
打石膏 apply the cast/plaster
保留石膏 retain
塑形石膏 mould
翻修或更新石膏 repair or renew
拆石膏 discard the cast
hasten /ˈheɪsn/vt. 加速；使赶紧；催促vi. 赶快；急忙
be treated in plaster 石膏治疗
the outcome is less predictable结果难以预测
immobilization /ɪˌmoʊbələˈzeɪʃn/n. 使停止流通，固定
percutaneous /ˌpɜːrkjuːˈteɪniəs/adj. 经皮的；经由皮肤的
though technically demanding尽管技术上有很高的要求
百度翻译：
治疗
舟状骨结节骨折无需夹板固定，应按手腕扭伤处理；使用绉带，并鼓励活动。其他舟状骨骨折的治疗方法如下。
不移位的骨折不需要复位，用石膏治疗；90%的腰部骨折应该愈合。石膏是从前臂上部到手指的掌骨指骨关节的短端，但包括拇指的近端指骨。手腕背屈，拇指向前，呈“玻璃托”姿势。灰泥必须小心地模制在
手，不分开。保留（必要时修理或更新）8周。
8周后取下石膏，进行临床和放射学检查。如果没有压痛，并且x光片显示有愈合迹象，则手腕可以自由活动；如果怀疑骨折愈合，CT扫描是最可靠的方法。
如果舟状骨很软，或者骨折在x光片上仍然可见，则再次使用石膏4周。在这个阶段，可能会出现两张照片中的一张：（a）手腕无痛，骨折已经愈合-石膏可以丢弃；（b）x光片显示延迟愈合的迹象（骨折周围的骨吸收和空化）-通过植骨和内固定可以加速愈合。
移位骨折也可以用石膏治疗，但结果不太可预测。最好切开复位，用加压螺钉固定。这将增加愈合的可能性并减少固定时间。
有些病人可能不想忍受长时间的石膏。早期经皮加压螺钉固定虽然技术要求很高，但可以显著减少离开工作的时间和与个人护理相关的困难。