骨科英文书籍精读（374）｜踝部骨折的并发症
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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OPEN FRACTURES
Open fractures of the ankle pose special problems. If the fracture is not reduced and stabilized at an early stage, it may prove impossible to restore the anatomy. For this reason unstable injuries should be treated by internal fixation even in the presence of an open wound, provided the soft tissues are not too severely damaged and the wound is not contaminated. If internal fixation seems too risky, an external fixator can be used, often as a temporary spanning option. Treatment in other respects follows the principles outlined in chapter 23.
Complications
EARLY
Vascular injury
With a severe fracture-subluxation the pulses may be obliterated. The ankle should be immediately reduced and held in a splint until definitive treatment has been initiated.
Wound breakdown and infection
Diabetic patients are at greater than usual risk of developing wound-edge necrosis and deep infection. In dealing with displaced fractures, these risks should be carefully weighed against the disadvantages of conservative treatment; casts may also cause skin problems if not well padded and are less effective in preventing malunion.
LATE
Incomplete reduction
Incomplete reduction is common and, unless the talus fits the mortise accurately, degenerative changes may occur. This can sometimes be prevented by a corrective osteotomy.
Non-union
The medial malleolus occasionally fails to unite because a flap of periosteum is interposed between it and the tibia. It should be prevented by operative reduction and screw fixation.
Joint stiffness
Swelling and stiffness of the ankle are usually the result of neglect in treatment of the soft tissues. The patient must walk correctly in plaster and, when the plaster is removed, he or she must, until circulatory control is regained, wear a crepe bandage and elevate the leg whenever it is not being used actively. Physiotherapy is always helpful.
Algodystrophy
This often follows fractures of the ankle. The patient complains of pain in the foot; there may be swelling and diffuse tenderness, with gradual development of trophic changes and severe osteoporosis. Management is discussed in Chapter 10.
Osteoarthritis
Malunion and/or incomplete reduction may lead to secondary osteoarthritis of the ankle in later years. Unless the ankle is unstable, symptoms can often be managed by judicious analgesic treatment and the use of firm, comfortable footwear. However, in the longer term if symptoms become severe arthrodesis may be necessary.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
provided /prəˈvaɪdɪd/conj. 假如，倘若
an external fixator can be used, often as a temporary spanning option. 可以使用外固定架，通常作为临时跨越选项。
obliterated /əˈblɪtəreɪtɪd/v. 摧毁；抹除（想法、感情或记忆）；（使）看不见；遮盖；盖销（尤指邮票）( obliterate 的过去式和过去分词 )
if not well padded and are less effective in preventing malunion. 如果填充物不够好，在预防畸形愈合方面效果较差。
corrective osteotomy截骨矫正术
crepe bandage 弹力绷带
Algodystrophy 痛性肌萎缩
diffuse tenderness,弥漫性压痛,
trophic /ˈtroʊfɪk/adj. 营养的；有关营养的
arthrodesis关节融合术
有道翻译（仅供参考，建议自己翻译）：
开放性骨折
踝关节开放性骨折带来了特殊的问题。如果骨折在早期没有复位和稳定，可能无法恢复解剖结构。因此，即使存在开放性伤口，只要软组织没有受到太严重的损伤，伤口没有受到污染，不稳定的损伤也应该通过内固定治疗。如果椎间固定风险太大，可以使用外固定器，通常作为临时跨越选择。其他方面的处理遵循第23章概述的原则。
并发症
早期
血管损伤
严重骨折半脱位时，脉搏可能会消失。踝关节应立即缩小并用夹板固定，直到开始明确的治疗。
伤口破裂和感染
糖尿病患者比平常更容易发生伤口边缘坏死和深部感染。在处理移位性骨折时，应仔细权衡这些风险与保守治疗的缺点；如果没有很好的填充，石膏也可能导致皮肤问题，并且在防止畸形愈合方面效果较差。
晚期并发症
不完全复位
不完全复位很常见，除非距骨与榫眼准确吻合，否则可能发生退行性变。这有时可以通过矫正截骨术来预防。
不愈合
内踝有时不能愈合，因为骨膜瓣插在它和胫骨之间。应通过手术复位和螺钉固定加以预防。
关节僵硬
踝关节的肿胀和僵硬通常是软组织治疗中忽视的结果。患者必须在石膏中正确行走，当石膏被移除时，他或她必须在恢复循环控制之前，佩戴绉纱绷带，并在不积极使用时抬高腿部。理疗总是有帮助的。
痛觉营养不良
这通常发生在脚踝骨折之后。病人抱怨脚痛；可能有肿胀和弥漫性压痛，并逐渐发展为营养性改变和严重骨质疏松。第10章讨论了管理。
骨关节炎
畸形愈合和/或不完全复位可能导致继发性踝关节骨性关节炎。除非脚踝不稳定，否则症状通常可以通过明智的止痛治疗和使用结实舒适的鞋来控制。然而，从长远来看，如果症状变得严重，关节融合术可能是必要的。