骨科英文书籍精读（105）｜肱骨内髁骨折
FRACTURES OF THE MEDIAL CONDYLE
This is much rarer than either a fracture of the lateral condyle or a separation of the medial epicondylar apophysis.
Mechanism of injury
The injury is usually caused by a fall from a height, involving either a direct blow to the point of the elbow or a landing on the outstretched hand with the elbow forced into valgus; in the latter case it would be an avulsion injury. The fracture line runs through the physis, exiting in the trochlear notch or even further laterally, and the medial fragment may be displaced by the pull of the flexor muscle group.
Clinical features and x-ray
This is an intra-articular fracture, resulting in considerable pain and swelling. In older children the metaphyseal component is usually easily visualized on x-ray. However, in young children much of the medial condylar epiphysis is cartilaginous and therefore not visible on x-ray, so the full extent of the fracture may not be recognized; seeing only the epicondylar ossific centre in a displaced position on the x-ray may mislead the surgeon into thinking that this is only an epicondylar fracture. In doubtful cases an arthrogram may be helpful.
Treatment
Undisplaced fractures are treated by splintage; x-rays are repeated until the fracture has healed, so as to ensure that it does not become displaced. Displaced fractures are treated by either closed reduction (sometimes with percutaneous pinning) or by open reduction and fixation with pins.Postoperative management is similar to that of lateral condyle fractures.
Complications
EARLY
Lateral dislocation of the elbow occasionally occurs with a severe valgus strain and avulsion of the medial condyle. Early reduction of both the dislocation and the fracture, if necessary by open operation and pinning, is important.
Ulnar nerve damage is not uncommon, but recovery is usual unless the nerve is left kinked in the joint.
LATE
Stiffness of the elbow is common and extension often limited for months; but, provided movement is not forced, it will eventually return.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
epicondylar/,epi'kɔndələ/adj. 上髁的
condylar/'kɔndilə/adj. 髁的
condyle /ˈkɑːndaɪl/n. 骨节；骨阜；髅状突起（形容词condylar）
apophysis /ə'pɑfəsɪs/n. 隆起；突起；岩脉的分支
physis /'faisis/n. 生长板；自然界生长原则；后缀生长
trochlear notch滑车切迹 /nɑːtʃ/n. 刻痕，凹口；等级；峡谷vt. 赢得；用刻痕计算；在…上刻凹痕
metaphyseal干骺端的
arthrogram关节造影片
百度翻译：
内髁骨折
这比外侧髁骨折或内侧上髁突分离都要罕见得多。
损伤机制
这种损伤通常是由从高处坠落引起的，包括直接击中肘部，或是用肘部伸入外翻的手着地；在后一种情况下，则是撕脱伤。骨折线穿过身体，出现在滑车切迹处，甚至进一步向外侧延伸，而内侧碎片可能在屈肌群的牵引下移位。
临床特征与x线表现
这是关节内骨折，导致相当大的疼痛和肿胀。在年龄较大的儿童中，干骺端的成分通常很容易在x光片上看到。然而，对于幼儿来说，大部分内侧髁状突骨骺是软骨性的，因此在x光片上看不到骨折的全部范围，因此在x光片上只看到髁上骨化中心移位，可能会误导外科医生认为这只是髁上骨折。在可疑病例中，关节造影可能有帮助。
治疗
不移位的骨折用夹板固定治疗；重复x光直到骨折愈合，以确保它不会移位。移位骨折可采用闭合复位（有时经皮穿针）或切开复位固定别针。术后治疗方法与外侧髁骨折相似。
早期并发症
肘关节外侧脱位偶有严重外翻劳损和内侧髁撕裂。早期复位脱位和骨折，必要时通过开放手术和钉扎，是很重要的。
尺神经损伤并不少见，但恢复通常是正常的，除非神经在关节处扭结。
晚期并发症
肘关节僵硬是很常见的，伸展通常会限制几个月；但是，只要不强迫运动，它最终会恢复。