骨科英文书籍精读（142）｜掌骨干骨折
FRACTURES OF THE METACARPAL SHAFT
A direct blow may fracture one or several metacarpal shafts transversely, often with associated skin damage. A twisting or punching force may cause a spiral fracture of one or more shafts. There is local pain and swelling, and sometimes a dorsal ‘hump’.
Treatment
Oblique or transverse fractures with slight displacement require no reduction. Splintage also is unnecessary, but a firm crepe bandage may be comforting; this should not be allowed to discourage the patient from active movements of the fingers, which should be practised assiduously. As the patient moves the fingers, the fracture may shorten until the intertacarpal ligaments between the metacarpal necks tighten, thus limiting further shortening and rotational deformity.
Transverse fractures with considerable displacement are reduced by traction and pressure. Reduction can sometimes be held by a plaster slab extending from the forearm over the fingers (only the damaged ones). The slab is maintained for 3 weeks and the undamaged fingers are exercised. However, these fractures are usually unstable and should be fixed surgically with compression plates or percutaneous K-wires placed either across the fracture or transversely through the neighbouring undamaged metacarpals.
Spiral fractures are liable to rotate; if so, they should be perfectly reduced and fixed with lag screws and a plate, or percutaneous wires.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
spiral /ˈspaɪrəl/n. 螺旋；旋涡；螺旋形之物adj. 螺旋形的；盘旋的
hump/hʌmp/n. 驼峰；驼背；圆形隆起物
discourage /dɪsˈkɜːrɪdʒ/vt. 阻止；使气馁
assiduously /əˈsɪdʒuəsli/adv. 刻苦地；勤勉地
百度翻译：
掌骨骨干骨折
直接击打可使一个或多个掌骨轴横向骨折，常伴有皮肤损伤。扭转或冲孔力可能导致一个或多个轴的螺旋破裂。有局部疼痛和肿胀，有时背部有“驼峰”。
治疗
轻微移位的斜向或横向骨折不需要复位。夹板固定也是不必要的，但是一条结实的绉布绷带可能会使人感到安慰；这不应妨碍患者手指的主动活动，而应刻苦练习。当患者移动手指时，骨折可能会缩短，直到掌骨颈之间的掌骨间韧带收紧，从而限制进一步缩短和旋转畸形。
具有相当大位移的横向裂缝通过牵引和压力减少。复位有时可以用石膏板从前臂延伸到手指上（只有受损的部分）。板坯维持3周，并锻炼undam 老化的手指。然而，这些骨折通常是不稳定的，应该用加压钢板或经皮K形钢丝固定在骨折处或横向穿过邻近未受损的掌骨。
螺旋骨折容易旋转；如果是这样，应该完全复位并用拉力螺钉和钢板或经皮钢丝固定。