骨科英文书籍精读（143）｜掌骨颈骨折
FRACTURES OF THE METACARPAL NECK
A blow may fracture the metacarpal neck, usually of the fifth finger (the ‘boxer’s fracture’) and occasionally one of the others. There may be local swelling, with flattening of the knuckle. X-rays show an impacted transverse fracture with volar angulation of the distal fragment.
Treatment
The main function of the fifth and fourth fingers is firm flexion (‘power grip’) and, as can be readily demonstrated on a normal hand, there is ‘spare’ extension available at the metacarpo-phalangeal (MCP) joint. Therefore in these digits, a flexion deformity of up to 40 degrees can be accepted; as long as there is no rotational deformity, a good outcome can be expected. The hand is immobilized in a gutter splint with the MCP joint flexed and the interphalangeal (IP) joints straight until discomfort settles – a week or two – and then the hand is mobilized. The patient is warned that the knuckle profile may be permanently lost. In the index and middle fingers, which function mainly in extension, no more than 20 degrees of flexion at the fracture is acceptable.
If the fracture needs reduction, this can be done under a local block. The reduced finger is held with a gutter splint moulded at three points to support the fracture; the MCP joints are flexed and the IP joints are straight. Unfortunately, these fractures are usually
fairly unstable because of the tone of the flexor tendons and the palmar comminution of the fracture. If there is a tendency to redisplacement, fixation should be used. Plates are not really suitable because the fracture is so distal. A bouquet of two or three bent wires passed distally through a hole in the styloid process of
the fifth metacarpal base is particularly effective.
Complications
Malunion, with volar angulation of the distal fragment, is poorly tolerated if this occurs in the second or third rays. The patient may be aware of a bump in the palm from the prominent metacarpal head and the digit may take on a ‘Z’ appearance as the knuckle joint hyperextends to compensate for the deformity.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
with flattening of the knuckle.把指关节弄平。
knuckle./ˈnʌkl/n. 关节；指关节；指节；膝关节；肘vi. 开始认真工作vt. 用指关节敲打
volar/ˈvoʊlər/adj. 手掌的，足底的；属于飞行的
as long as只要；和…一样长
gutter /ˈɡʌtər/n. 排水沟；槽；贫民区
vi. 流；形成沟vt. 开沟于…；弄熄adj. 贫贱的；粗俗的；耸人听闻的
profile /ˈproʊfaɪl/n. 侧面；轮廓；外形；剖面；简况vt. 描…的轮廓；扼要描述vi. 给出轮廓
permanently /ˈpɜːrmənəntli/adv. 永久地，长期不变地
If there is a tendency to redisplacement, fixation should be used.如果有移位的倾向，应使用固定。
bouquet /buˈkeɪ/n. 花束；酒香
compensate for the deformity.补偿畸形。
百度翻译：
掌骨颈骨折
击打可能会骨折掌骨颈部，通常是指的第五个手指（“拳击手骨折”），有时也可能是其他的一个。可能有局部肿胀，关节变平。X光片显示一个阻生的横向骨折，远端碎片的掌侧成角。
治疗
第五和第四个手指的主要功能是788个稳固的屈曲（“力量握力”），而且，正如在普通手上可以很容易地证明的那样，掌骨指骨（MCP）关节处有“备用”伸展。因此，在这些手指中，可以接受40度的屈曲畸形；只要没有旋转畸形，就可以期待良好的外展。手被固定在水槽夹板上，MCP关节弯曲，指骨间关节伸直，直到不适感缓解（一周或两周），然后手就可以活动了。警告患者，指关节轮廓可能经常丢失。以食指屈伸不超过20度为主要功能。
如果骨折需要复位，可以在局部阻滞下进行。用三点成型的沟槽夹板固定复位手指，以支撑骨折；MCP关节弯曲，IP关节平直。不幸的是，这些骨折通常
由于屈肌十指肌的张力和骨折的掌侧粉碎，相当不稳定。如果有重新放置的倾向，应使用固定。钢板不太合适，因为骨折太远了。一束由两根或三根弯曲的金属丝组成的束，从远端穿过茎突的一个孔
第五掌骨基底特别有效。
后遗症
畸形愈合，远端肢体掌侧成角，如果发生在第二或第三光线，耐受性较差。患者可能意识到手掌突出的掌骨头部有肿块，手指关节过度伸展以补偿畸形时，手指可能呈现“Z”形外观。