骨科英文书籍精读（150）｜指骨骨折（2）
Treatment
UNDISPLACED FRACTURES
These can be treated by ‘functional splintage’. The finger is strapped to its neighbour (‘buddy strapping’) and movements are encouraged from the outset. Splintage is retained for 2–3 weeks, but during this time it is wise to check the position by x-ray in case displacement has occurred.
DISPLACED FRACTURES
Displaced fractures must be reduced and immobilized. It is essential to check for rotational correction by (1) noting the convergent position of the finger when the MCP joint is flexed, and (2) seeing that the fingernails are all in the same plane. The technique depends on the fracture pattern. Most need simple manipulation and can then be held in a splint. Basal fractures with extension are manipulated and held with a dorsal blocking splint with the MCP joint at 90 degrees. Angulated basal fractures are manipulated with a pencil between the digits as a lever and then held with neighbour strapping which pulls the injured finger to the next one. Spiral fractures are held with ‘de-rotation taping’ to the next digit, using tension in the tape to unwind the fracture. Transverse fractures may be held in a gutter splint or neighbour splint.
If a reduction cannot be achieved, or if it is unstable and the position slips, then surgery is needed. The technique depends upon the configuration of the fracture. K-wires are less invasive and are perfect for some fractures; other techniques include percutaneous lag screw fixation (for spiral fractures and distal condylar fractures) and plate fixation (which risks stiffness in the proximal phalanx due to the soft-tissue exposure and subsequent tendon adhesion). External fixation may be needed for comminuted fractures.
CHILDHOOD FRACTURES
In children the phalangeal neck can be broken, often after a crush injury. The distal fragment displaces dorsally and extends. These are serious injuries and should be reduced as soon as possible and then held with a percutaneous wire.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
strapped /stræpt/v. 用带子系（strap 的过去式和过去分词）adj. 缺钱的，手头拮据的
from the outset从一开始
unwind/ˌʌnˈwaɪnd/vt. 放松；解开；[计] 展开vi. 放松；解开；松开
gutter splint沟形夹
configuration /kənˌfɪɡjəˈreɪʃn/n. 配置；结构；外形
tendon adhesion肌腱粘连
百度翻译：
治疗
不移位骨折
这些可以通过“功能性夹板固定”来治疗。790的手指被绑在它的邻居身上（“兄弟捆绑”），从一开始就鼓励人们活动。夹板固定2-3周，但在此期间，最好通过x光检查位置，以防移位。
移位骨折
移位的骨折必须复位固定。有必要通过以下方法检查旋转校正：（1）当MCP关节弯曲时，注意手指的收敛位置；（2）确保鳍钉都在同一平面上。这项技术取决于骨折类型。大多数需要简单的操作，然后可以用夹板夹住。基底骨折伴伸展是操纵和固定的背侧封闭夹板与MCP关节在90度。有角度的基底骨折是用铅笔在手指之间作为杠杆进行操作，然后用相邻的捆扎带将受伤的手指拉到下一个手指上。螺旋骨折用“去旋转胶带”固定到下一个手指，利用胶带中的张力来解开骨折。横向骨折可以用沟槽夹板或相邻夹板固定。
如果复位不能实现，或者如果复位不稳，位置下滑，则需要手术。该技术取决于压裂液的结构。K-线的侵入性较小，对某些骨折非常理想；其他技术包括经皮拉力螺钉固定（用于螺旋骨折和远端髁状突骨折）和钢板固定（由于软组织暴露和随后的肌腱粘连，近节指骨有僵硬的风险）。粉碎性骨折可能需要外固定。
儿童骨折
儿童的指骨颈可以骨折，通常是挤压伤后。远端碎片移位并延伸。这些都是严重的伤害，应尽快减少，然后用经皮钢丝固定。