骨科英文书籍精读（146）｜第一掌骨骨折
FRACTURE OF THE THUMB METACARPAL
Three types of fracture are encountered: impacted fracture of the metacarpal base; Bennett’s fracture-dislocation of the carpo-metacarpal (CMC) joint; and Rolando’s comminuted fracture of the base.
Impacted fracture
A boxer may, while punching, sustain a fracture of the base of the first metacarpal. Localized swelling and tenderness are found, and x-ray shows a transverse fracture about 6 mm distal to the CMC joint, with outward bowing and impaction.
Treatment
If the angulation is less than 20–30 degrees and the fragments are impacted, the thumb is rested in a plaster of Paris cast extending from the forearm to just short of the interphalangeal thumb joint with the thumb fully abducted and extended. The cast is removed after 2–3 weeks and the thumb is mobilized.
If the angulation is greater than 30 degrees, then the reduced thumb web span will be noticeable and so the fracture should be reduced. The surgeon pulls on the abducted thumb and, by levering the metacarpal outwards against his own thumb, corrects the bowing. A plaster cast is applied. If the fracture is still unstable, then a percutaneous K-wire is inserted. An alternative would be a low profile plate.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
encountered /ɪn'kaʊntɚ/v. 遇到；曾遭遇（encounter的过去式）
impacted fracture嵌插骨折
Bennett’s fracture-dislocation of the carpo-metacarpal (CMC) joint; and Rolando’s comminuted fracture of the base. 班尼特(Bennett)腕掌关节骨折脱位;还有罗兰多的粉碎性骨折。
abduct /æbˈdʌkt/vt. 绑架；诱拐；使外展
abducted thumb外展的拇指
lever /ˈlevər/n. 杠杆；控制杆vt. 用杠杆撬动；把…作为杠杆vi. 用杠杆撬
bow /baʊ; boʊ/n. 弓；蝴蝶结；琴弓；船头v. 鞠躬，点头；低（头）；屈从；（使）弯曲；用琴弓拉奏（弦乐器）
alternative /ɔːlˈtɜːrnətɪv/n. 二中择一；供替代的选择adj. 供选择的；选择性的；交替的
百度翻译：
拇指掌骨骨折
骨折有三种类型：掌骨基底部撞击骨折；贝内特骨折；腕掌关节位置不稳；罗兰多基底粉碎性骨折。
撞击骨折
拳击手在打拳时，可能会造成第一掌骨底部骨折。局部肿胀和压痛，x光片显示CMC关节远端约6 mm处出现横向骨折，并向外弯曲和嵌塞。
治疗
如果角度小于20-30度，并且碎片受到撞击，拇指被放在从前臂延伸到指间拇指关节的巴黎石膏中，拇指完全外展和伸展。2-3周后取出石膏，拇指活动。
如果角度大于30度，那么拇指蹼的长度会明显减少，因此骨折应该减少。外科医生拉着外展的拇指，通过向外撬动掌骨抵住自己的拇指，矫正弓形。用石膏浇铸。如果骨折仍然不稳定，则应插入经皮K-线。另一种选择是低调。