骨科英文书籍精读（86）｜肱骨远端骨折（3）
Treatment
These are severe injuries associated with joint damage; prolonged immobilization will certainly result in a stiff elbow. Early movement is therefore a prime objective.
Undisplaced fractures
These can be treated by applying posterior slab with the elbow flexed almost 90 degrees; movements are commenced after 2 weeks. However, great care should be taken to avoid the dual pitfalls of underdiagnosis (displacement and comminution are not always obvious on the initial xray) and late displacement (always obtain check x-rays a week after injury).
Displaced Type B and C fractures
If the appropriate expertise and facilities are available, open reduction and internal fixation is the treatment of choice for displaced fractures (some would say for all Type B and C fractures – minor displacement is easily overlooked in the early post-injury x-rays). The danger with conservative treatment is the strong tendency to stiffening of the elbow and persistent pain.
Good exposure of the joint is needed, if necessary by performing an intra-articular olecranon osteotomy. The ulnar nerve should be identified and protected throughout. The fragments are reduced and held temporarily with K-wires. A unicondylar fracture without comminution can then be fixed with screws; if the fragment is large, a contoured plate is added to prevent re-displacement. First the articular block is reconstructed with a transverse screw; bone graft is sometimes needed. The distal block is then fixed to the humeral shaft with medial and lateral plates. Precontoured plates with locking screws are now available. These hold the distal fragments more effectively.
Postoperatively the elbow is held at 90 degrees with the arm supported in a sling. Movement is encouraged but should never be forced. Fracture healing usually occurs by 12 weeks. Despite the best efforts, the patient often does not regain full extension and in the most severe cases movement may be severely restricted.
A description of this sort fails to convey the real difficulty of these operations. Unless the surgeon is more than usually skilful, the elbow may end up stiffer than if treated by activity (see below).
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
prime objective.主要目标。
These can be treated by applying posterior slab with the elbow flexed almost 90 degrees; 这些可以通过在肘部弯曲近90度的情况下使用后夹板（石膏）来治疗;
commence/kəˈmens/v. 开始；着手；<英>获得学位
dual pitfalls双重陷阱
/ˈduːəl/n. 双数；双数词adj. 双的；双重的
/ˈpɪtfɔːl/n. 陷阱，圈套；缺陷；诱惑
underdiagnosis诊断不足
expertise /ˌekspɜːrˈtiːz/n. 专门知识；专门技术；专家的意见
overlooked 忽略；
throughout./θruːˈaʊt/adv. 自始至终；遍及
block /blɑːk/n. 块；街区；大厦；障碍物vt. 阻止；阻塞；限制；封盖
百度翻译：
治疗
这些是与关节损伤相关的严重伤害；长时间固定肯定会导致肘部僵硬。因此，早期运动是主要目标。
未移位的骨折
这些可以通过施加后板进行处理，肘部弯曲近90度；2周后开始运动。然而，应特别注意避免诊断不足（初始x射线的位移和粉碎并不总是明显）和晚期位移（总是在受伤后一周获得检查x射线）的双重缺陷。
移位的B型和C型骨折
如果有适当的专业知识和设施，开放复位和内固定是移位骨折的首选治疗方法（有些人会说所有B型和C型骨折-在伤后早期x射线很容易忽略轻微移位）。保守治疗的危险是肘部僵硬和持续疼痛的强烈倾向。
如果需要，通过进行关节内鹰嘴截骨术需要良好的关节暴露。尺神经应始终被识别和保护。碎片减少并用K线暂时保持。然后可以用螺钉固定没有粉碎的单髁骨折；如果碎片很大，则加入异形板以防止再次移位。首先用横向螺钉重建关节块；有时需要骨移植。然后用内侧和外侧板将远端块固定到肱骨干上。现在可以使用带有锁定螺钉的预成型板。这些更有效地保持远端碎片。
术后肘部保持90度，手臂支撑在吊带上。运动是令人鼓舞的，但不应该被迫。骨折愈合通常在12周内发生。尽管付出了最大的努力，但患者通常无法恢复完全伸展，在最严重的情况下，运动可能会受到严重限制。
这种描述无法传达这些操作的真正困难。除非外科医生通常技术熟练，否则肘部可能比通过活动治疗时更硬（见下文）。