骨科英文书籍精读（358）｜单纯胫骨骨折
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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FRACTURE OF TIBIA ALONE
A direct injury, such as a kick or blow with a club, may cause a transverse or slightly oblique fracture of the tibia alone at the site of impact. In children, the fracture is usually caused by an indirect injury; the fibula is intact or may show plastic deformation.
Local bruising and swelling are usually evident, but knee and ankle movements are possible. Transverse or slightly oblique fractures are easy to spot on x-ray even if displacement is slight. The child with a spiral fracture may be able to stand on the leg, and as the fracture may be almost invisible in an anteroposterior film, the injury can be missed unless two views are obtained; a few days later an angry mother brings the child back with a lump that proves to be callus!
Treatment
If the fracture is displaced, reduction should be attempted. An above-knee plaster is applied as with a fracture of both bones; first a split plaster and then, when swelling has subsided, a complete one. A fracture of the tibia alone takes just as long to unite as if both bones were broken, so at least 12 weeks is needed for consolidation and sometimes much longer. The child with a spiral fracture, however, can be safely released after 6 weeks; and with a mid-shaft transverse fracture the surgeon may (if he or she is a skilled plasterer and reduction is perfect) replace the above-knee plaster by a short plaster gaiter.
Complications
Delayed union
Isolated tibial fractures, especially in the lower third, may be slow to join and the temptation is to discard splintage too soon. Even slight displacement and loss of contact at the fracture level may delay union, so internal fixation is often preferred as primary treatment. This fracture also has a tendency to drif into varus in the later stages of healing; sometimes a fibular osteotomy is needed to allow correction of the deformity at surgery.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
club /klʌb/n. 俱乐部，社团；夜总会；棍棒；（扑克牌中的）梅花vt. 用棍棒打；募集
gaiter /ˈɡeɪtər/n. 绑腿；长筒橡胶靴
temptation /tempˈteɪʃn/n. 引诱；诱惑物；诱因
有道翻译（仅供参考，建议自己翻译）：
单纯胫骨骨折
直接损伤，如用棍子踢或击打，可能导致胫骨在撞击部位发生横向或轻微倾斜骨折。在儿童中，骨折通常是由间接损伤引起的；腓骨完整或可能出现塑性变形。
局部瘀伤和肿胀通常是明显的，但膝盖和脚踝的运动是可能的。即使移位很小，x线也很容易发现横向或轻微倾斜的骨折。螺旋形骨折的儿童可以站在腿上，由于骨折在前后位片中几乎看不见，除非获得两个视图，否则可能会错过损伤；几天后，一位愤怒的母亲带着一个被证明是老茧的肿块回来了！
治疗
如果骨折移位，应尝试复位。膝盖以上的膏药用于两块骨头的骨折；首先是一个分裂石膏，然后，当肿胀消退，一个完整的。单是胫骨骨折愈合的时间就跟两块骨头都骨折一样长，所以至少需要12周才能愈合，有时甚至更长。然而，患有螺旋形骨折的儿童在6周后可以安全出院；对于中段横断骨折，外科医生可以（如果他或她是一个熟练的整形者，复位是完美的）用短石膏绑腿代替膝盖以上的石膏。
并发症
延迟愈合孤立性胫骨骨折，尤其是在下三分之一，可能是缓慢的加入和诱惑是放弃夹板过早。即使骨折处轻微移位或失去接触也可能延迟愈合，因此内固定通常是首选的主要治疗方法。这种骨折在愈合的后期也有向内翻的趋势；有时需要腓骨截骨术来矫正手术中的畸形。