骨科英文书籍精读（116）｜桡骨远端骨折（1）
FRACTURES OF THE DISTAL RADIUS IN ADULTS
The distal end of the radius is subject to many different types of fracture, depending on factors such as age, transfer of energy, mechanism of injury and bone quality.
With any of these fractures, the wrist also can suffer substantial ligamentous injury causing instability to the carpus or distal radio-ulnar joint. These injuries are easily missed because the x-rays may look normal.
COLLES’ FRACTURE
The injury that Abraham Colles described in 1814 is a transverse fracture of the radius just above the wrist, with dorsal displacement of the distal fragment. It is the most common of all fractures in older people, the high incidence being related to the onset of postmenopausal osteoporosis. Thus the patient is usually an older woman who gives a history of falling on her outstretched hand.
Mechanism of injury and pathological anatomy
Force is applied in the length of the forearm with the wrist in extension. The bone fractures at the corticocancellous junction and the distal fragment collapses into extension, dorsal displacement, radial tilt and shortening.
Clinical features
We can recognize this fracture (as Colles did long before radiography was invented) by the ‘dinner-fork’ deformity, with prominence on the back of the wrist and a depression in front. In patients with less deformity there may only be local tenderness and pain on wrist movements.
X-ray
There is a transverse fracture of the radius at the corticocancellous junction, and often the ulnar styloid process is broken off. The radial fragment is impacted into radial and backward tilt. Sometimes there is an intra-articular fracture; sometimes it is severely comminuted.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
substantial /səbˈstænʃl/n. 本质；重要材料adj. 大量的；实质的；内容充实的
carpus /'kɑrpəs/n. [解剖] 腕骨；[解剖] 腕；手腕子
dorsal displacement 背侧移位/ˈdɔːrsl/adj. （鱼或动物）背部的；
postmenopausal/,postmɛnə'pɔzəl/adj. （妇女）绝经后的
the corticocancellous junction 皮质松质骨交界处
prominence /ˈprɑːmɪnəns/n. 突出；显著；突出物；卓越
百度翻译：
成人桡骨远端骨折
桡骨远端有许多不同类型的骨折，这取决于年龄、能量转移、损伤机制和骨质量等因素。
在这些骨折中，腕关节也可能遭受严重的韧带损伤，导致腕关节或桡尺关节远端不稳定。这些伤很容易漏诊，因为x光检查看起来很正常。
COLLES骨折
1814年亚伯拉罕·科莱斯描述的损伤是腕关节上方桡骨的横向骨折，远端碎片背侧移位。它是老年人最常见的骨折，其高发病率与绝经后骨质疏松症的发病有关。因此，患者通常是一位年长的女性，她有摔倒在伸出的手上的病史。
损伤机制与病理解剖
力施加在前臂的长度上，手腕伸直。皮质松质骨接合部骨折和远端骨折片塌陷为伸展、背侧移位、桡侧倾斜和缩短。
临床特征
我们可以通过“餐叉”畸形来识别这种骨折（在放射照相术发明之前很久，科莱斯就已经这样做了），手腕后部突出，前部凹陷。对于畸形较小的患者，可能只有手腕运动时的局部压痛和疼痛。
X射线
桡骨皮质-小脑交界处横断性骨折，常伴有尺骨茎突断裂。径向碎片被撞击成径向和后倾。有时关节内骨折，有时严重粉碎。