骨科英文书籍精读（21）｜骨折内固定的并发症
Complications of internal fixation
Most of the complications of internal fixation are due to poor technique, poor equipment or poor operating conditions:
Infection Iatrogenic infection is now the most common cause of chronic osteomyelitis; the metal does not predispose to infection but the operation and quality of the patient’s tissues do.
Non-union If the bones have been fixed rigidly with a gap between the ends, the fracture may fail to unite.
This is more likely in the leg or the forearm if one bone is fractured and the other remains intact. Other causes of non-union are stripping of the soft tissues and damage to the blood supply in the course of operative fixation.
Implant failure Metal is subject to fatigue and can fail unless some union of the fracture has occurred. Stress must therefore be avoided and a patient with a broken tibia internally fixed should walk with crutches and stay away from partial weightbearing for 6 weeks or longer, until callus or other radiological sign of fracture healing is seen on x-ray. Pain at the fracture site is a danger signal and must be investigated.
Refracture It is important not to remove metal implants too soon, or the bone may refracture. A year is the minimum and 18 or 24 months safer; for several weeks after removal the bone is weak, and care or protection is needed.
---from 《Apley’s System of Orthopaedics and Fractures》P703
重点词汇整理：
Iatrogenic /aɪ,ætrə'dʒɛnɪk/adj. 医源性的；因医生的治疗而引起的
osteomyelitis /,ɑstɪo,maɪə'laɪtɪs/n. [外科] 骨髓炎
predispose /ˌpriːdɪˈspoʊz/vt. 预先处置；使…偏向于;易于...
stripping of the soft tissues 软组织剥离
fatigue /fəˈtiːɡ/n. 疲劳adj. 疲劳的vt. 使疲劳；使心智衰弱
crutches /ˈkrʌtʃɪz/n. 拐杖，支撑物；叉状架（crutch复数）
partial weightbearing 部分负重
百度翻译：
内固定并发症
大多数内固定术后并发症是由于技术差、设备差或操作条件差造成的：
感染 医源性感染是目前慢性骨髓炎最常见的病因；金属不易感染，但患者组织的操作和质量却易感染。
不愈合 如果骨头被固定在末端之间有间隙，骨折可能无法愈合。
如果一根骨头骨折，另一根保持完整，这更可能发生在腿部或前臂。不愈合的其他原因是手术固定过程中软组织剥离和血液供应受损。
植入物失效 金属容易疲劳，除非骨折愈合，否则可能失效。因此，必须避免应力，胫骨内固定骨折的患者应拄拐杖行走，并在6周或更长时间内远离部分负重，直到在x光片上看到骨痂或骨折愈合的其他放射征象。骨折部位的疼痛是一个危险信号，必须进行调查。
再骨折 重要的是不要过早取出金属植入物，否则骨头可能会发生骨折。一年是最短的，18或24个月更安全；在取出后的几周内，骨头很脆弱，需要护理或保护。