骨科英文书籍精读（389）｜跟骨关节外骨折的治疗
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Treatment
For all except the most minor injuries, the patient is admitted to hospital so that the leg and foot can be elevated and treated with cold (ice or Cryo-Cuff) and compression until swelling subsides. This also gives time to obtain the necessary CT scans.
EXTRA-ARTICULAR FRACTURES
The byword for the management of extra-articular fractures is 'mobility and function are more important than anatomical repositioning’. The vast majority are treated closed: (1) compression bandaging, ice packs and elevation until the swelling subsides; (2) exercises as soon as pain permits; (3) no weightbearing for 4 weeks and partial weightbearing for another 4 weeks. Variations from this routine relate to specific injuries.
Fractures of the anterior process
Most of these are avulsion fractures and many are mistaken for an ankle sprain. Oblique x-rays will show the fracture, which almost always involves the calcaneocuboid joint. If there is a large displaced fragment, internal fixation may be needed; this is followed by the usual 'closed’ routine.
Fractures of the tuberosity
These are usually due to avulsion by the tendo Achillis; clinical signs are similar to those of a torn Achilles tendon. If the fragment is displaced, it should be reduced and fixed with cancellous screws; the foot is then immobilized in slight equinus to relieve tension on the tendo Achillis. Weightbearing can be permitted after 4 weeks.
Fractures of the body
If it is certain that the subtalar joint is not involved, the prognosis is good and the fracture can be treated by the usual 'closed’ routine. However, if there is much sideways displacement and widening of the heel, closed reduction by manual compression should be attempted. Weightbearing is avoided for 6–8 weeks; however, cast immobilization is unnecessary except if both heels are fractured or if the patient simply cannot manage a one-legged gait with crutches (e.g. those who are elderly or frail).
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
byword /ˈbaɪwɜːrd/n. 谚语，俗语；格言；笑柄
'mobility and function are more important than anatomical repositioning’.灵活性和功能比解剖学上的重新定位更重要”。
calcaneocuboid joint跟骰关节
the foot is then immobilized in slight equinus to relieve tension on the tendo Achillis. 然后将脚固定在轻微的跖屈上，以缓解跟腱的紧张。
equinus马蹄足(跖屈)
those who are elderly or frail老年人或体弱者
frail /freɪl/adj. 脆弱的；虚弱的n. 灯心草篓；少妇；少女
DeepL翻译（仅供参考，建议自己翻译）：
治疗方法
除了最轻微的伤害外，所有的病人都要入院治疗，以便抬高腿部和脚部，进行冷敷（冰敷或冷冻袖套）和压迫治疗，直到肿胀消退。这也为获得必要的CT扫描提供了时间。
关节外骨折
处理关节外骨折的口号是 "活动能力和功能比解剖学上的重新定位更重要"。绝大多数是闭合治疗。(1)加压包扎、冰袋和抬高，直到肿胀消退；(2)在疼痛允许的情况下尽快锻炼；(3)4周内不负重，另外4周内部分负重。这一程序的变化与特定的损伤有关。
前突的骨折
大多数是撕脱性骨折，许多被误认为是踝关节扭伤。倾斜的X线片可以显示骨折，几乎总是涉及到小腿骨关节。如果有较大的移位碎片，可能需要进行内固定；然后是通常的 "闭合 "程序。
小结石的骨折
这通常是由于跟腱撕脱造成的；临床症状与跟腱撕裂相似。如果碎片移位，应将其缩小并用松质螺钉固定；然后将足部固定为轻微的等高位，以减轻跟腱的张力。4周后可允许负重。
身体的骨折
如果确定没有涉及到胫骨下关节，则预后良好，可以通过通常的 "闭合 "程序治疗骨折。但是，如果有很多侧向移位和脚跟变宽，应尝试通过人工压迫进行闭合复位。6-8周内避免负重；然而，石膏固定是不必要的，除非两个脚跟都骨折，或者病人根本无法使用拐杖进行单腿步态（如那些年老或虚弱的人）。