骨科英文书籍精读（375）｜Pilon骨折
我们正在精读国外经典骨科书籍《Apley’s System of Orthopaedics and Fractures》，想要对于骨科英文形成系统认识，为以后无障碍阅读英文文献打下基础，请持续关注。
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PILON FRACTURES
Unlike the twisting injuries that cause the common ankle fractures, this injury to the ankle joint occurs when a large force drives the talus upwards against the tibial plafond, like a pestle (pilon) being struck into a mortar. There is considerable damage to the articular cartilage and the subchondral bone may be broken into several pieces; in severe cases, the comminution extends some way up the shaft of the tibia.
Clinical features
There may be little swelling initially but this rapidly changes and fracture blisters are common. The ankle may be deformed or even dislocated; prompt approximate reduction is mandatory.
X-rays
This is a comminuted fracture of the distal end of the tibia, extending into the ankle joint. The fracture may be classified according to the amount of displacement and comminution (Rüedi and Allgöwer, 1979), though this will usually require accurate definition by CT. Rüedi type 1 is an intra-articular fracture with little or no displacement of the fragments; in type 2 there is more severe disruption of the articular surface but without very marked comminution. Type 3 is a severely comminuted fracture with displacement of the fragments and gross articular irregularity.
In all cases, assessment is far better with CT scanning (preferably including three-dimensional reconstruction) than with plain x-ray examination.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
plafond, /plə'fɔn, plɑ:'fuŋ/n. 装饰的天花板；天花板画
like a pestle (pilon) being struck into a mortar.就像杵杵进臼里。
prompt approximate reduction is mandatory.立即（大概）复位是强制性的。
mandatory /ˈmændətɔːri/adj. 强制的；托管的；命令的n. 受托者（等于mandatary）
gross /ɡroʊs/adj. 总共的；粗野的；恶劣的；显而易见的；恶心的vt. 总共收入n. 总额，总数
In all cases, assessment is far better with CT scanning (preferably including three-dimensional reconstruction) than with plain x-ray examination.在所有病例中，CT扫描(最好包括三维重建)的评估要远远好于x线平片检查。
有道翻译（仅供参考，建议自己翻译）：
pilon骨折
与造成普通踝关节骨折的扭伤不同，这种踝关节损伤是在一个巨大的力推动距骨向上抵住胫骨平台时发生的，就像一个杵（pilon）被敲入一个关节
迫击炮。关节软骨有相当大的损伤，软骨下骨可能碎裂成几块；在严重的情况下，粉碎会延伸到胫骨干。
临床特征
最初可能很少肿胀，但变化很快，常见骨折水泡。踝关节可能变形甚至脱臼；必须立即近似减少。
X射线
胫骨远端粉碎性骨折，延伸至踝关节。骨折可根据移位量和粉碎量（Rüedi和Allgö沃尔，1979年），尽管这通常需要CT的准确定义。Rüedi 1型是一种关节内骨折，骨折块轻微移位或无移位；2型关节面破坏更严重，但无明显粉碎。3型为严重粉碎性骨折，骨折块移位，关节面大体不规则。
在所有的病例中，CT扫描（最好包括三维重建）的评估都比普通x光检查好得多。