骨科英文书籍精读（82）｜肱骨干骨折（3）
Complications
EARLY
Vascular injury
If there are signs of vascular insufficiency in the limb, brachial artery damage must be excluded. Angiography will show the level of the injury. This is an emergency, requiring exploration and either direct repair or grafting of the vessel. In these circumstances, internal fixation is advisable.
Nerve injury
Radial nerve palsy (wrist drop and paralysis of the metacarpophalangeal extensors) may occur with shaft fractures, particularly oblique fractures at the junction of the middle and distal thirds of the bone (Holstein–Lewis fracture). If nerve function was intact before manipulation but is defective afterwards, it must be assumed that the nerve has been snagged and surgical exploration is necessary. Otherwise, in closed injuries the nerve is very seldom divided, so there is no hurry to operate as it will usually recover. The wrist and hand must be regularly moved through a full passive range of movement to preserve joint motion until the nerve recovers. If there is no sign of recovery by 12 weeks, the nerve should be explored. It may just need a neurolysis, but if there is loss of continuity of normal-looking nerve then a graft is needed. The results are often satisfactory but, if necessary, function can be largely restored by tendon transfers (see Chapter 11).
LATE
Delayed union and non-union
Transverse fractures sometimes take months to unite, especially if excessive traction has been used (a hanging cast must not be too heavy). Simple adjustments in technique may solve the problem; as long as there are signs of callus formation it is worth persevering with non-operative treatment, but remember to keep the shoulder moving. The rate of non-union in conservatively treated low-energy fractures is less than 3 percent. Segmental high energy fractures and open fractures are more prone to both delayed union and non-union.
Intramedullary nailing may contribute to delayed union, but if rigid fixation can be maintained (if necessary by exchange nailing) the rate of non-union can probably be kept below 10 percent.
A particularly vicious combination is incomplete union and a stiff joint. If elbow or shoulder movements are forced before consolidation of the fracture, or if an intramedullary nail is removed too soon (e.g., because of shoulder problems), the humerus may refracture and non-union is then more likely.
The treatment of established non-union is operative. The bone ends are freshened, cancellous bone graft is packed around them and the reduction is held with an intramedullary nail or a compression late.
Joint stiffness
Joint stiffness is common. It can be minimized by early activity, but transverse fractures (in which shoulder abduction is ill-advised) may limit shoulder movement for several weeks.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
brachial artery [解剖] 肱动脉；[解剖] 臂动脉
Angiography美/ændʒɪ'ɑgrəfi/ 血管造影术；血管照相术；血管学；[特医] 血管造影法
If nerve function was intact before manipulation but is defective afterwards, it must be assumed that the nerve has been snagged and surgical exploration is necessary.如果在操作前神经功能完好，但操作后神经功能有缺陷，则必须假定神经已受阻，需要手术探查。
neurolysis /njʊ'rɑləsɪs/n. 精神疲惫；神经组织崩溃;神经松解术
are more prone to更倾向于 /proʊn/adj. 俯卧的；有…倾向的，易于…的
vicious /ˈvɪʃəs/adj. 恶毒的；恶意的；堕落的；有错误的；品性不端的；剧烈的
ill-advised/ˌɪl ədˈvaɪzd/adj. 不明智的；失策的；不理智的；没脑筋的；欠考虑的
百度翻译：
并发症
早期
血管损伤
如果肢体有血管功能不全的迹象，必须排除肱动脉损伤。血管造影将显示损伤程度。这是一个紧急情况，需要探索和直接修理或嫁接船只。在这种情况下，内固定是可取的。
神经损伤
骨干骨折可能会发生Radial神经麻痹（手腕掉落和掌指伸肌麻痹），尤其是在骨骼中部和远端三分之一交界处的倾斜骨折（荷斯坦-刘易斯骨折）。如果神经功能在操作前是完整的，但之后是有缺陷的，则必须假定神经已被堵塞并且手术探查是必要的。否则，在闭合性损伤中，神经很少分裂，因此不必急于操作，因为它通常会恢复。手腕和手必须定期移动通过完全被动的运动范围，以保持关节运动，直到神经恢复。如果在12周内没有恢复的迹象，应该探索神经。它可能只需要神经松解，但如果正常神经的连续性丧失，则需要移植物。结果通常令人满意，但如有必要，可通过肌腱转移在很大程度上恢复功能（见第11章）。
晚期
延迟愈合和不愈合
横向骨折有时需要几个月才能愈合，特别是如果使用过度牵引（悬挂铸件不得太重）。技术上的简单调整可以解决问题；只要有愈伤组织形成的迹象，就值得坚持非手术治疗，但请记住保持肩膀移动。保守治疗的低能量骨折的不愈合率低于3%。节段性高能量骨折和开放性骨折更容易发生延迟愈合和不愈合。
髓内钉可能导致延迟愈合，但如果可以保持刚性固定（如果需要交换钉），则不愈合率可能会保持在10%以下。
一个特别恶毒的组合是不完全的结合和僵硬的关节。如果在巩固骨折之前强制进行肘部或肩部移动，或者如果髓内钉过早移除（例如，由于肩部问题），肱骨可能会再次骨折并且不愈合的可能性更大。
已建立的不愈合的治疗是有效的。骨端被新鲜化，松质骨移植物被包裹在它们周围，并且用髓内钉或晚期压缩保持减少。
关节僵硬
关节僵硬很常见。它可以通过早期活动最小化，但横向骨折（不建议肩外展）可能会限制肩部运动数周。