骨科英文书籍精读（28）｜开放性骨折的后遗症
SEQUELS TO OPEN FRACTURES
Skin
If split-thickness skin grafts are used inappropriately, particularly where flap cover is more suited, there can be areas of contracture or friable skin that breaks down intermittently. Reparative or reconstructive surgery by a plastic surgeon is desirable.
Bone
Infection involves the bone and any implants that may have been used. Early infection may present as wound inflammation without discharge. Identifying the causal organism without tissue samples is difficult but, at best guess, it is likely to be S. aureus (including methicillin-resistant varieties) or Pseudomonas. Suppression by appropriate antibiotics, as long as the fixation remains stable, may allow the fracture to proceed to union, but further surgery is likely later, when the antibiotics are stopped.
Late presentation may be with a sinus and x-ray evidence of sequestra. The implants and all avascular pieces of bone should be removed; robust soft tissue cover (ideally a flap) is needed. An external fixator can be used to bridge the fracture. If the resulting defect is too large for bone grafting at a later stage, the patient should be referred to a centre with the necessary experience and facilities for limb reconstruction.
Joints
When an infected fracture communicates with a joint, the principles of treatment are the same as with bone infection, namely debridement and drainage, drugs and splintage. On resolution of the infection, attention can be given to stabilizing the fracture so that joint movement can recommence. Permanent stiffness is a real threat; where fracture stabilization cannot be achieved to allow movement, the joint should be splinted in the optimum position for ankylosis, lest this should occur.
---from 《Apley’s System of Orthopaedics and Fractures》P710
重点词汇整理：
SEQUEL /ˈsiːkwəl/n. 续集；结局；继续；后果
split-thickness skin grafts刃厚皮片移植
inappropriately,/ˌɪnəˈproʊpriətli/adv. 不适当地
contracture 美 /kən'træktʃɚ/n. [医] 挛缩；异位骨化
friable /ˈfraɪəbl/adj. 易碎的；脆弱的
intermittently /ˌɪntərˈmɪtəntli/adv. 间歇地
Reparative /'rɛpərətɪv/adj. 修缮的；赔偿的；弥补的
Reparative or reconstructive surgery修复或重建手术
Early infection may present as wound inflammation without discharge。早期感染可表现为无分泌物的伤口炎症。
causal organism病原生物/ˈkɔːzl/n. 表示原因的连词adj. 因果关系的；有原因的
S. aureus 金黄色葡萄球菌（staphylococcus aureus）
methicillin-resistant varieties耐甲氧西林的品种
Pseudomonas /,psjʊdo'monæs/n. 假单胞菌
Suppression/səˈpreʃn/n. 抑制；镇压；[植] 压抑
Late presentation may be with a sinus and x-ray evidence of sequestra. 晚期的表现可能是窦性和x光片显示的死骨。
sinus /ˈsaɪnəs/n. [生物] 窦；静脉窦；下陷或凹下去的地方
sequestra /sɪ'kwɛstrə/《复数形式》 死骨，死骨片
sequestrum /sɪ'kwɛstrəm/《单数形式》
avascular /ei'væskjulə/adj. [医] 无血管的
communicate with a joint与关节相通（感染到关节）
namely /ˈneɪmli/adv. 也就是；即是；换句话说
recommence /ˌriːkəˈmens/vt. 重新开始vi. 重新开始
Permanent stiffness永久性的僵硬
ankylosis /ˌæŋkɪˈloʊsɪs/n. [外科] 关节僵硬；胶着
lest/lest/conj. 唯恐，以免；（引出产生某种情感的原因）唯恐，担心
splinted in the optimum position for ankylosis 功能位固定
百度翻译：
开放性骨折的后遗症
皮肤
如果不恰当地使用中厚皮片移植，特别是在皮瓣覆盖更合适的地方，可能会有挛缩或脆弱的皮肤区域间歇性地破裂。由整形外科医生进行修复或重建手术是可取的。
骨头
感染包括骨头和可能使用过的任何植入物。早期感染可表现为伤口发炎而无分泌物。在没有组织样本的情况下鉴定致病微生物是困难的，但最多只能猜测是金黄色葡萄球菌（包括耐甲氧西林的品种）或假单胞菌。只要固定保持稳定，适当的抗生素支持可以使骨折愈合，但当抗生素停止后，可能会进行进一步的手术。
晚期的表现可能是窦性和x光片显示的死骨。植入物和所有无血管的骨块都应该移除；需要坚固的软组织覆盖物（理想情况下是一个皮瓣）。可使用外固定器桥接骨折。如果所产生的缺损太大，不能在后期进行骨移植，则应将患者转到具有必要经验和设施的中心进行肢体重建。
关节
感染性骨折与关节相通时，治疗原则与骨感染相同，即清创引流、药物和夹板固定。在解决感染问题时，应注意稳定骨折，使关节活动重新开始。永久性僵硬是一个真正的威胁；当骨折不能稳定以允许移动时，关节应在强直的最佳位置用夹板固定，以免发生这种情况。