骨科英文书籍精读（251）｜儿童股骨近端骨折的治疗
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Treatment
These fractures should be treated as a matter of urgency, and certainly within 24 hours of injury. Initially the hip is supported or splinted while investigations are carried out. Early aspiration of the intracapsular haematoma is advocated by some authors as a means of reducing the risk of epiphyseal ischaemia; however, the benefits are uncertain and the matter is controversial.
Undisplaced fractures may be treated by immobilization in a plaster spica for 6–8 weeks. However, fracture position is not always maintained and there is a considerable risk of late displacement and malunion or non-union.
Displaced type IV fractures also can be treated nonoperatively: closed reduction, traction and spica immobilization. Careful follow-up is essential; if position is lost, operative fixation will be needed.
Type I, II and III fractures are treated by closed reduction and then internal fixation with smooth pins or cannulated screws. ‘Closed reduction’ means one gentle manipulation; if this fails, open reduction is performed. In small children, operative fixation is supplemented by a spica cast for 6–12 weeks.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
aspiration /ˌæspəˈreɪʃn/n. 渴望；抱负；送气；吸气；吸引术
haematoma /,hi:mə'təumə, ,hem-/n. [病理] 血肿
epiphyseal/,epi'fiziəl/adj. 骺的；脑上体的
ischaemia/is'ki:miə/n. 局部贫血
the matter is controversial这个问题有争议
spica/ˈspaɪkə/n. 穗状花序；人字形绷带；
supplemented /ˈsʌplɪmentɪd/v. 增补，补充
百度翻译：
治疗
这些骨折应该紧急处理，当然要在受伤后24小时内处理。在进行研究时，首先要用支撑或夹板固定髋关节。早期抽吸囊内血肿是一些作者提倡作为一种手段，以减少骨骺缺血的风险，但是，好处是不确定的，这个问题是有争议的。
未移位的骨折可以用石膏钉固定6-8周。然而，骨折位置并不总是保持不变，并且有相当大的晚期移位和畸形愈合或不愈合的风险。
移位的IV型骨折也可以非手术治疗：闭合复位、牵引和spica固定。仔细的随访是必要的；如果位置丢失，则需要手术固定。
Ⅰ、Ⅱ、Ⅲ型骨折采用闭合复位，然后用光滑钉或空心螺钉内固定。“闭合复位”指一次温和的操作；如果操作失败，则进行开放复位。对于小孩，手术固定由spica管支撑6-12周。