骨科英文书籍精读（103）｜肱骨内上髁分离（1）
SEPARATION OF THE MEDIAL EPICONDYLE
Mechanism of injury and pathology
The medial epicondyle begins to ossify at the age of about 5 years and fuses to the shaft at about 16; between these ages it may be avulsed by a severe muscle or ligament strain. The child falls on the outstretched hand with the wrist and elbow extended; the elbow is wrenched into valgus. The unfused epicondylar apophysis is avulsed by tension on either the wrist flexor muscles or the medial ligament of the elbow. If the elbow subluxates (even momentarily), the small apophyseal fragment may be dragged into the joint. With more severe injuries the joint dislocates laterally.
Clinical features
The diagnosis should be suspected if injury is followed by pain, swelling and bruising on the medial side of the elbow. If the joint is dislocated, deformity is of course obvious. Sensation and power in the fingers should be tested to exclude concomitant ulnar nerve damage.
X-ray
In the anteroposterior view the medial epicondylar epiphysis may be tilted or shifted downwards; if the joint is dislocated the fragment lies distal to the lower humerus. A lateral view may show the epicondyle looking like a loose body in the joint. If in any doubt, the normal side should be x-rayed for comparison (see Fig. 24.36 d–g).
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
epicondyle英 /,epi'kɔndail/ 美 /,epi'kɔndail/n. [解剖] 上髁
wrench /rentʃ/n. 扳手，扳钳；扭伤；痛苦；歪曲；猛扭vt. 扭伤；猛扭；曲解；折磨
avulse /əˈvʌls/v. 抽出；撕裂，撕脱
valgus /vælɡəs/n. 外翻足的人；外翻足adj. 外翻的
apophysis /ə'pɑfəsɪs/n. 隆起；突起；岩脉的分支
subluxate使半脱位/ˈlʌkseɪt/v. 使脱臼；使骨脱节
concomitant /kənˈkɑːmɪtənt/n. 伴随物adj. 相伴的；共存的；附随的
tilt /tɪlt/n.v. 倾斜
a loose body游离体
If in any doubt, the normal side should be x-rayed for comparison。如有疑问，应照x光检查正常侧以作比较。
百度翻译：
内侧上髁分离
损伤机制与病理学内侧上髁在大约5岁时开始骨化，在16岁左右融合到骨干；在这两个年龄之间，可能会因严重的肌肉或韧带拉伤而撕裂。孩子摔倒在伸开的手上，手腕和肘部伸开；肘部被拧成外翻。未融合的上髁隆起由于腕屈肌或肘关节内侧韧带的张力而撕裂。如果肘关节半脱位（即使是暂时的），小的隆起碎片可能会被拖入关节。更严重的损伤会导致关节侧脱位。
临床特征
如果受伤后肘部内侧疼痛、肿胀和瘀伤，则应怀疑诊断。如果关节脱臼，畸形当然很明显。应测试手指的感觉和力量，以排除伴随的尺神经损伤。
X射线
在前位视野中，内侧上髁骨骺可能倾斜或向下移动；如果关节脱位，则碎片位于肱骨下段的远端。从侧面看，上髁在关节处看起来像一个松散的身体。如有任何疑问，应对正常侧进行x光检查以进行比较（见图24.36 d–g）。