骨科英文书籍精读（381）｜距骨损伤机制及特点
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。
中国十大名师之一赖世雄老师说过，学习英语没有捷径，少就是多，快就是慢。不要以量取胜，把一个音标、一个单词、一段对话、一篇文章彻底搞透，慢慢积累，你会发现，你并不比每天走马观花的输入大量英文学的差。
Mechanism of injury
Fracture of the talar neck is produced by violent hyperextension of the ankle. The neck of the talus is forced against the anterior edge of the tibia, which acts like a cleaver. If the force continues, the fracture is displaced and the surrounding joints may sublux or dislocate.
Fracture of the body is usually a compression injury due to a fall from a height, or an everting force across the body, fracturing the lateral process (the snowboarders’ fracture). Avulsion fractures are associated with ligament strains around the ankle and hindfoot.
Clinical features
The patient has most commonly been involved in a motor vehicle accident or has fallen from a height. The foot and ankle are painful and swollen; if the fracture is displaced, there may be an obvious deformity, or the skin may be tented or split. Tenting is a dangerous sign; if the fracture or dislocation is not promptly reduced, the skin may slough and become infected. The pulses should be checked and compared with those in the opposite foot.
X-ray
Anteroposterior, lateral and oblique views are essential; CT scanning helps to identify associated injuries of the ankle and foot. Both malleoli, the ankle mortise, the talus and all the adjacent tarsal bones should be carefully assessed. Undisplaced fractures are not always easy to see, and sometimes even severely displaced fractures are missed in the initial assessment because of unfamiliarity with the normal appearance–sad but true.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
cleaver /ˈkliːvər/n. 切肉刀；[五金] 劈刀
evert /ɪ'vɜːrt/v. 使……外翻；翻转
snowboarder滑雪板
Avulsion fractures are associated with ligament strains around the ankle and hindfoot.撕脱性骨折与踝关节和后足周围的韧带拉伤有关。
Avulsion fractures 撕脱性骨折
the skin may slough and become infected皮肤会脱落(溃烂)并受到感染
slough /slaʊ/n. 蜕下的皮（或壳）；绝境；[地理] 泥沼；[外科] 腐肉vt. 使陷入泥沼；抛弃vi. 蜕皮；脱落；在泥浆中跋涉
tarsal /'tɑ:səl/adj. 跗骨的；眼睑软骨的n. 跗骨
talus /ˈteɪləs/n. 距骨；踝；斜面
talar距骨的
ankle mortise踝穴
有道翻译（仅供参考，建议自己翻译）：
损伤机制
距骨颈骨折是由于踝关节剧烈过度伸展造成的。距骨的颈部被压在胫骨的前边缘，就像一把劈刀。如果这种力持续下去，骨折就会移位，周围的关节可能会出现半脱位或脱臼。
身体的骨折通常是由于从高处坠落造成的压迫性损伤，或者是由于身体上的外翻力，使侧面的过程破裂（滑雪板运动员的骨折）。撕脱骨折与踝关节和后脚周围的韧带拉伤有关。
临床特征
患者最常见的情况是发生机动车事故或从高处坠落。足踝疼痛肿胀；如果骨折移位，可能会有明显的畸形，或者皮肤可能会起帐篷或裂开。帐篷是危险的标志；如果骨折或脱位没有及时复位，皮肤可能会脱落并感染。应检查脉搏，并与另一只脚的脉搏进行比较。
X射线
前后、侧视和斜视是必要的；CT扫描有助于确定踝关节和足部的相关损伤。踝关节、踝榫、距骨和所有邻近的跗骨都应仔细评估。未移位的骨折并不总是很容易看到，有时甚至严重移位的骨折也会因为不熟悉正常的外观而在初始评估中被遗漏——悲伤但真实。