骨科英文书籍精读（385）｜距骨骨折的并发症
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Complications
Malunion
The importance of accurate reduction has been stressed. Malunion may lead to distortion of the joint surface, limitation of movement and pain on weightbearing. If early follow-up x-rays show redisplacement of the fragments, a further attempt at reduction is justified. Persistent malunion predisposes to osteoarthritis.
Avascular necrosis
Avascular necrosis of the body of the talus occurs in displaced fractures of the talar neck. The incidence varies with the severity of displacement: in type 1 fractures it is less than 10 per cent; in type 2 about 30–40 per cent; and in type 3 more than 90 percent. The earliest x-ray sign (often present by the sixth week) is apparent increased density of the avascular segment; in reality it is the rest of the tarsus that has become slightly porotic with disuse, but the avascular portion remains unaffected and therefore looks more 'dense’. The opposite is also true: if the dome of the talus becomes osteoporotic, this means that it has a blood supply and it will not develop osteonecrosis. This is the basis of Hawkins’ sign, which should be looked for 6–8 weeks after injury.
If osteonecrosis does occur, the body of the talus will eventually appear on x-ray to be more dense than the surrounding bones. Despite necrosis, the fracture may heal, so treatment should not be interrupted by this event; if anything, weightbearing should be delayed in the hope that the bone is not unduly flattened. Function may yet be reasonable. However, if the talus becomes flattened or fragmented, or pain and disability are marked, the ankle may need to be arthrodesed.
Secondary osteoarthritis
Osteoarthritis of the ankle and/or subtalar joints occurs some years after injury in over 50 percent of patients with talar neck fractures. There are a number of causes: (1) articular damage due to the initial trauma; (2) malunion and distortion of the articular surface; (3) avascular necrosis of the talus. Pain and stiffness may be managed by judicious analgesic medication and orthotic adjustments, but in some cases the painful hindfoot will simply not allow a return to function; arthrodesis of the affected joints can help to relieve symptoms. Operative fusion of one joint may predispose to overload of the associated foot joints, and hence to later arthritis, but this should be accepted.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
justified. /ˈdʒʌstɪfaɪd/adj. 合乎情理的；有正当理由的；事出有因的
Persistent malunion predisposes to osteoarthritis.持续性畸形愈合易导致骨关节炎。
predispose /ˌpriːdɪˈspoʊz/vt. 预先处置；使…偏向于
in reality it is the rest of the tarsus that has become slightly porotic with disuse, but the avascular portion remains unaffected and therefore looks more 'dense’. 事实上，跗骨的其他部分由于废弃而变得有点多孔，但无血管的部分没有受到影响，因此看起来更“致密”。
osteoporotic骨质疏松的
porotic/pə'rɔtik/adj. 多孔性的；骨质疏松的n. 促骨痂生长药
osteonecrosis骨坏死
unduly /ˌʌnˈduːli/adv. 过度地；不适当地；不正当地
judicious analgesic 明智的止痛剂
judicious /dʒuˈdɪʃəs/adj. 明智的；头脑精明的；判断正确的
analgesic /ˌænəlˈdʒiːzɪk/adj. （药剂）镇痛的n. 镇痛剂
arthrodesis =Operative fusion of one joint 关节融合术
DeepL翻译（仅供参考，建议自己翻译）：
并发症
畸形愈合
已经强调了准确缩小的重要性。融合不良可能导致关节表面变形、活动受限和负重时疼痛。如果早期随访的X线片显示碎片重新移位，就有理由进一步尝试缩小。持续的错位容易导致骨关节炎。
缺血性坏死
距骨体的血管性坏死发生在距骨颈移位的骨折中。发生率随移位的严重程度而变化：在1型骨折中低于10%；在2型中约30-40%；而在3型中超过90%。最早的X线征象（通常在第6周出现）是无血管部分的密度明显增加；实际上是跗关节的其他部分由于不使用而变得轻微多孔，但无血管部分仍未受到影响，因此看起来更 "密集"。反之亦然：如果距骨的圆顶变得骨质疏松，这意味着它有血液供应，不会发生骨坏死。这是霍金斯征的基础，应在受伤后6-8周内寻找。
如果确实发生了骨坏死，距骨的主体最终会在X光片上显示比周围的骨头更密集。尽管发生了坏死，但骨折可能会愈合，所以治疗不应该因为这个事件而中断；如果有的话，应该推迟负重，希望骨头不会被过度压扁。功能可能仍然是合理的。然而，如果距骨变得扁平或碎裂，或者疼痛和残疾很明显，踝关节可能需要进行关节置换。
继发性骨关节炎
50%以上的距骨颈骨折患者在受伤多年后发生踝关节和/或跖骨关节的骨关节炎。原因有很多。(1) 由于最初的创伤造成的关节损伤；(2) 关节表面的错位和变形；(3) 距骨的血管性坏死。疼痛和僵硬可以通过明智的镇痛药物和矫形器调整来控制，但在某些情况下，疼痛的后足根本不允许恢复功能；受影响关节的关节融合术可以帮助缓解症状。一个关节的手术融合可能会导致相关的足部关节的过度负荷，从而导致以后的关节炎，但这应该被接受。