骨科英文书籍精读（87）｜肱骨远端骨折（4）

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ALTERNATIVE METHODS OF TREATMENT

If it is anticipated that the outcome of operative treatment will be poor (either because of the degree of comminution and soft-tissue damage or because of lack of expertise and facilities) other options can be considered.

Elbow replacement

The elderly patient with a comminuted fracture, a low transverse fracture or osteopaenic bone, may be best served by replacement of the elbow.

The ‘bag of bones’ technique

The arm is held in a collar and cuff or, better, a hinged brace, with the elbow flexed above a right angle; active movements are encouraged as soon as the patient is willing. The fracture usually unites within 6–8 weeks, but exercises are continued far longer. A useful range of movement (45–90 degrees) is often obtained.

Skeletal traction

An alternative method of treating either moderately displaced or severely comminuted fractures is by skeletal traction through the olecranon (beware the ulnar nerve!); the patient remains in bed with the humerus held vertical, and elbow movements are encouraged. Again, meticulous internal fixation or elbow replacement are usually preferable.

---from 《Apley’s System of Orthopaedics and Fractures》

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重点词汇整理：

meticulous /məˈtɪkjələs/adj. 一丝不苟的；小心翼翼的；拘泥小节的

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百度翻译：

治疗的替代方法

如果预期手术治疗的效果不佳(或由于粉碎程度和软组织损伤，或由于缺乏专业知识和设备)，可以考虑其他选择。

肘部替换

老年患者粉碎性骨折，低横位骨折或骨性骨折，最好是更换肘关节。

“骨头包”技术

手臂用项圈和袖口，或者更好的是用铰链支撑，肘部弯曲到一个直角以上;

只要病人愿意，就鼓励他们积极活动。骨折通常在6-8周内愈合，但锻炼持续的时间要长得多。通常可以得到一个有用的运动范围(45-90度)。

骨牵引术

另一种治疗中度移位或严重粉碎性骨折的方法是通过鹰嘴骨牵引(注意尺神经!)

病人躺在床上，保持肱骨垂直，鼓励肘部活动。同样，谨慎的内固定或肘关节置换术通常是可取的。

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