骨科英文书籍精读（109）｜桡尺骨骨折（1）
FRACTURES OF THE RADIUS AND ULNA
Mechanism of injury and pathology
Fractures of the shafts of both forearm bones occur quite commonly. A twisting force (usually a fall on the hand) produces a spiral fracture with the bones broken at different levels. An angulating force causes a transverse fracture of both bones at the same level. A direct blow causes a transverse fracture of just one bone, usually the ulna. Additional rotation deformity may be produced by the pull of muscles attached to the radius: they are the biceps and supinator muscles to the upper third, the pronator teres to the middle third, and the pronator quadratus to the lower third. Bleeding and swelling of the muscle compartments of the forearm may cause circulatory impairment.
Clinical features
The fracture is usually quite obvious, but the pulse must be felt and the hand examined for circulatory or neural deficit. Repeated examination is necessary in order to detect an impending compartment syndrome.
X-RAY
Both bones are broken, either transversely and at the same level or obliquely with the radial fracture usually at a higher level. In children, the fracture is often incomplete (greenstick) and only angulated. In adults, displacement may occur in any direction – shift, overlap, tilt or twist. In low-energy injuries, the fracture tends to be transverse or oblique; in high-energy injuries it is comminuted or segmental.
Treatment
CHILDREN
In children, closed treatment is usually successful because the tough periosteum tends to guide and then control the reduction. The fragments are held in a well-moulded full-length cast, from axilla to metacarpal shafts (to control rotation). The cast is applied with the elbow at 90 degrees. If the fracture is proximal to pronator teres, the forearm is supinated; if it is distal to pronator teres, then the forearm is held in neutral. The position is checked by x-ray after a week and, if it is satisfactory, splintage is retained until both fractures are united (usually 6–8 weeks).Throughout this period hand and shoulder exercises are encouraged. The child should avoid contact sports for a few weeks to prevent re-fracture.
Occasionally an operation is required, either if the fracture cannot be reduced or if the fragments are unstable. Fixation with intramedullary rods is preferred, but they should be inserted with great care to avoid injury to the growth plates. Alternatively, a plate or K-wire fixation can be used.
Childhood fractures usually remodel well, but not if there is any rotational deformity or an angular deformity of more than 15 degrees in children under 6 years or 10 degrees in children between 6 and 12. In those over 12 years old even slight angular deformities are unlikely to remodel satisfactorily.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
biceps /ˈbaɪseps/n. 二头肌（尤指肱二头肌和股二头肌）
supinator/'sjʊpə,netɚ/n. 旋后肌；走路（或跑步）外八字的人
pronator /ˈproʊˌneɪtər/n. [解剖] 旋前肌
pronator teres 旋前圆肌
teres /'te,ri:z/n. [解剖] 圆肌adj. 圆柱状的
pronator quadratus旋前方肌
neural deficit神经缺陷 /ˈdefɪsɪt/n. 赤字；不足额
impending/ɪmˈpendɪŋ/adj. 即将发生的；迫切的；悬挂的
axilla /æk'silə/n. [解剖] 腋窝，[解剖] 腋下；咯肢窝
metacarpal /ˌmetəˈkɑːrpl/n. 掌骨adj. 掌部的
supinate/'sʊpənet/v. 外旋；（使）（手、脚）掌面朝上；外八字行走（或奔跑）
intramedullary rod 弹性髓内钉
/,intrə,me'dʌləri/adj. [解剖] 髓内的
rod /rɑːd/n. 棒；惩罚；枝条；权力
百度翻译：
桡骨和尺骨骨折
损伤机制与病理
两个前臂骨的骨干骨折很常见。扭力（通常是摔在手上）会产生螺旋状骨折，骨头在不同程度上断裂。成角力导致两块骨头在同一水平面发生横向骨折。直接打击只会造成一块骨头的横向骨折，通常是尺骨。附加于桡骨的肌肉的牵拉可能会产生额外的旋转畸形：它们是位于上三分之一处的二头肌和旋后肌，位于中三分之一的旋前圆肌，以及位于下三分之一的旋前方肌。前臂肌肉室出血和肿胀可能导致循环障碍。
临床特征
骨折通常很明显，但必须能感觉到脉搏，并检查手部是否有循环或神经缺陷。反复检查是必要的，以发现一个迫在眉睫的筋膜室综合征。
X射线
两块骨头都骨折了，要么是横向的，在同一水平面上，要么是斜向的，桡骨骨折通常在更高的水平。在儿童，骨折通常是不完整的（绿色的）和只有角度。在成人身上，移位可能发生在任何方向——移位、重叠、倾斜或扭曲。在低能量损伤中，骨折倾向于横向或斜向；在高能损伤中，骨折是粉碎性或节段性的。
治疗
儿童
对于儿童，闭合治疗通常是成功的，因为坚硬的骨膜往往引导并控制复位。碎片被固定在一个成型良好的全长铸件中，从腋窝到掌骨轴（以控制旋转）。铸造时弯头呈90度角。如果骨折位于旋前圆肌近端，前臂旋后；如果骨折位于旋前圆肌远端，则前臂保持中立。一周后用x光片检查位置，如果满意，夹板固定直到两个骨折愈合（通常6-8周）。
在这段时间里，鼓励手和肩的练习。孩子在几周内应避免接触运动，以防止再骨折。
有时需要手术，如果骨折不能复位或碎片不稳定。最好用髓内棒固定，但应小心插入，以免损伤生长板。或者，也可以使用钢板或K线固定。
儿童骨折通常重建良好，但如果有任何旋转畸形或角畸形超过15度（6岁以下）或10度（6至12岁）的儿童则不能。在那些超过12岁的人中，即使是轻微的角变形也不可能令人满意地重塑。