骨科英文书籍精读（397）｜跖骨损伤
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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INJURIES OF METATARSAL BONES
Metatarsal fractures are relatively common and are of four types: (1) crush fractures due to a direct blow; (2) a spiral fracture of the shaft due to a twisting injury; (3) avulsion fractures due to ligament strains;
(4) insufficiency fractures due to repetitive stress.
Clinical features
In acute injuries pain, swelling and bruising of the foot are usually quite marked; with stress fractures, the symptoms and signs are more insidious.
X-rays should include routine anteroposterior, lateral and oblique views of the entire foot; multiple injuries are not uncommon. Undisplaced fractures may be difficult to detect and stress fractures usually show nothing at all until several weeks later.
Treatment
Treatment will depend on the type of fracture, the site of injury and the degree of displacement.
UNDISPLACED AND MINIMALLY DISPLACED FRACTURES
These can be treated by support in a below-knee cast or removable boot splint; the foot is elevated and active movements are started immediately, partial weightbearing for about 4–6 weeks. At the end of that period, exercise is very important and the patient is encouraged to resume normal activity. Slight malunion rarely results in disability once mobility has been regained.
DISPLACED FRACTURES
Displaced fractures can usually be treated closed. The foot is elevated until swelling subsides. The fracture may be reduced by traction under anaesthesia and the leg immobilized in a cast – non-weightbearing – for 4 weeks. Alternatively the fracture position might be accepted, depending on the degree of displacement.
For the second to fifth metatarsals, displacement in the coronal plane can be accepted and closed treatment, as above, is satisfactory. However, for the first metatarsal and for all fractures with significant displacement in the sagittal plane (i.e. depression or elevation of the displaced fragment) open reduction and internal fixation with K-wires, or better with stable fixation using a plate and small screws, is advisable. A below-knee cast is applied and weightbearing is avoided for 3 weeks; this is then replaced by a weightbearing cast for another 4 weeks.
Fractures of the metatarsal neck have a tendency to displace, or re-displace, with closed immobilization. It is therefore important to check the position repeatedly if closed treatment is used. If the fracture is unstable, it may be possible to maintain the position by percutaneous K-wire or screw fixation. The wire is removed after 4 weeks; cast immobilization is retained for 4–6 weeks.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
insufficiency fractures due to repetitive stress.重复应力引起的不完全骨折
insidious /ɪnˈsɪdiəs/adj. 阴险的；隐伏的；暗中为害的；狡猾的n. （Insidious）《潜伏》（电影名）
Slight malunion rarely results in disability once mobility has been regained.轻微的畸形愈合很少会在活动能力恢复后导致残疾。
Alternatively/ɔːlˈtɜːrnətɪvli/adv. 要不，或者；非此即彼；二者择一地；作为一种选择
sagittal plane矢状平面
/ˈsædʒətəl/adj. 矢状的，前后向的；（位于）矢形面的；箭样的
DeepL翻译（仅供参考，建议自己翻译）：
跖骨的损伤
跖骨骨折是比较常见的，有四种类型。(1)由于直接打击造成的粉碎性骨折；(2)由于扭伤造成的轴的螺旋形骨折；(3)由于韧带拉伤造成的撕脱性骨折。
(4)由于重复性的压力造成的不完全性骨折。
临床特征
在急性损伤中，足部的疼痛、肿胀和瘀伤通常相当明显；对于应力性骨折，其症状和体征更为隐蔽。
X线检查应包括整个足部的常规前后位、侧位和斜位检查；多处损伤并不罕见。未移位的骨折可能难以发现，应力性骨折通常在几周后才显示出来。
治疗方法
治疗方法取决于骨折的类型、受伤的部位和移位的程度。
未移位和轻微移位的骨折
这些可以通过膝下石膏或可拆卸的靴子夹板支撑来治疗；抬高脚部，立即开始主动运动，部分负重约4-6周。在这一时期结束时，锻炼是非常重要的，鼓励病人恢复正常活动。一旦恢复了活动能力，轻微的错位很少会导致残疾。
移位性骨折
移位的骨折通常可以进行闭合治疗。脚被抬高，直到肿胀消退。在麻醉状态下，可以通过牵引减少骨折，并将腿固定在石膏上--不负重--4周。另外，根据移位的程度，可以接受骨折的位置。
对于第二至第五跖骨，冠状面的移位是可以接受的，如上所述的封闭治疗是令人满意的。然而，对于第一跖骨和所有在矢状面有明显移位的骨折（即移位片段的凹陷或抬高），建议使用K线进行开放复位和内固定，或者最好使用钢板和小螺钉进行稳定固定。使用膝下石膏，3周内避免负重；然后用负重石膏代替，再使用4周。
跖骨颈部的骨折有移位的倾向，或在闭合固定后重新移位。因此，如果采用闭合治疗，反复检查位置是很重要的。如果骨折不稳定，可以通过经皮K线或螺钉固定来维持位置。4周后拆除钢丝；石膏固定保留4-6周。