骨科英文书籍精读（130）｜腕舟骨骨折（2）
Clinical features
The appearance may be deceptively normal, but the astute observer can usually detect fullness in the anatomical snuffbox; precisely localized tenderness in the same place is an important diagnostic sign; the scaphoid can of course also be palpated from the front and back of the wrist and it may be tender there as well. Proximal pressure along the axis of the thumb may be painful.
X-ray
Anteroposterior, lateral and oblique views are all essential; often a recent fracture shows only in the oblique view. Usually the fracture line is transverse, and through the narrowest part of the bone (waist), but it may be more proximally situated (proximal pole fracture). Sometimes only the tubercle of the scaphoid is fractured.
It is very important to look for subtle signs of displacement or instability: e.g. obliquity of the fracture line, opening of the fracture line, angulation of the distal fragment and foreshortening of the scaphoid image.
A few weeks after the injury the fracture may be more obvious; if union is delayed, cavitation appears on either side of the break. Old, un-united fractures have ‘hard’ borders, making it seem as if there is an extra carpal bone. Relative sclerosis of the proximal fragment is pathognomonic of avascular necrosis.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
The appearance may be deceptively normal, but the astute observer can usually detect fullness in the anatomical snuffbox;外观可能看似正常，但敏锐的观察者通常能察觉到鼻烟盒的丰满;
deceptively/dɪˈseptɪvli/adv. 看似；不像看上去那么；比实际更显得
waist /weɪst/n. 腰，腰部
wrist /rɪst/n. 手腕；腕关节vt. 用腕力移动
subtle /ˈsʌtl/adj. 微妙的；精细的；敏感的；狡猾的；稀薄的
cavitation美 /ˌkævəˈteɪʃən/n. [流] 气穴现象；空穴作用；成穴
sclerosis /skləˈroʊsɪs/n. [病理] 硬化，[医] 硬化症；细胞壁硬化
pathognomonic /pəˌθɑːɡnəˈmɑːnɪk/adj. 特殊（病征）的；能确定诊断的
百度翻译：
临床特征
外观可能看似正常，但敏锐的观察者通常可以在解剖鼻烟窝中发现饱腹感；同一部位精确定位的压痛是一个重要的诊断标志；舟状骨当然也可以从腕部的前后部触诊到，也可能在那里很嫩。沿拇指轴的近端压力可能是痛苦的。
X射线
正位、侧位和斜位都是必要的；最近的骨折通常只在斜位显示。通常骨折线是横向的，穿过骨的最窄部分（腰部），但它可能位于更近的位置（近端柱骨折）。有时只有舟状骨结节骨折。
寻找移位或不稳定的细微迹象是非常重要的：例如骨折线的倾斜、骨折线的开口、远端碎片的角度和舟骨图像的缩短。
损伤几周后，骨折可能更明显；如果愈合延迟，骨折两侧就会出现空化。陈旧的、不愈合的骨折有“硬”的边界，看起来好像有一块额外的腕骨。近端碎片相对硬化是缺血性坏死的病理学表现。