骨科英文书籍精读（16）｜骨折牵引和石膏
Complications of traction
Circulatory embarrassment --In children especially, traction tapes and circular bandages may constrict the circulation; for this reason ‘gallows traction’, in which the baby’s legs are suspended from an overhead beam, should never be used for children over 12 kg in weight.
Nerve injury-- In older people, leg traction may predispose to peroneal nerve injury and cause a dropfoot; the limb should be checked repeatedly to see that it does not roll into external rotation during traction.
Pin site infection --Pin sites must be kept clean and should be checked daily.
CAST SPLINTAGE
Plaster of Paris is still widely used as a splint, especially for distal limb fractures and for most children’s fractures. It is safe enough, so long as the practitioner is alert to the danger of a tight cast and provided pressure sores are prevented. The speed of union is neither greater nor less than with traction, but the patient can go home sooner. Holding reduction is usually no problem and patients with tibial fractures can bear weight on the cast. However, joints encased in plaster cannot move and are liable to stiffen; stiffness, which has earned the sobriquet ‘fracture disease’, is the problem with conventional casts. While the swelling and haematoma resolve, adhesions may form that bind muscle fibres to each other and to the bone; with articular fractures, plaster perpetuates surface irregularities (closed reduction is seldom perfect) and lack of movement inhibits the healing of cartilage defects. Newer substitutes have some advantages over plaster (they are impervious to water, and also lighter) but as long as they are used as full casts the basic drawback is the same.
Stiffness can be minimized by: (1) delayed splintage – that is, by using traction until movement has been regained, and only then applying plaster; or (2) starting with a conventional cast but, after a few weeks, when the limb can be handled without too much discomfort, replacing the cast by a functional brace which permits joint movement.
Plaster techniqueApplying a well-fifitting and effective plaster needs experience and attention to detail. (a) A well-equipped plaster trolley is invaluable. (b) Adequate anaesthesia and careful study of the x-ray films are both indispensable. (c) For a below-knee plaster the thigh is best supported on a padded block. (d) Stockinette is threaded smoothly onto the leg. (e) For a padded plaster the wool is rolled on and it must be even. (f) Plaster is next applied smoothly, taking a tuck with each turn, and (g) smoothing each layer firmly onto the one beneath. (h)While still wet the cast is moulded away from the point points. (i) With a recent injury the plasteris then split.
---from 《Apley’s System of Orthopaedics and Fractures》P687-688
重点词汇整理：
Complications /,kɑmplə'keʃən/n. 并发症（complication的复数）
Circulatory embarrassment 循环障碍
/ɪmˈbærəsmənt/n. 窘迫，难堪；使人为难的人或事物；拮据
constrict the circulation 限制循环
constrict /kənˈstrɪkt/vt. 压缩；束紧
beam /biːm/n. 横梁；光线
predispose /ˌpriːdɪˈspoʊz/vt. 预先处置；使…偏向于
dropfoot足下垂
external rotation外旋
Pin sites 钉道
CAST SPLINTAGE石膏夹板固定
pressure sores 压疮
sores /sor/n. 疡；褥疮；痍（sore的复数）
encased adj. 包装的；被包住的v. 盖住；包起；装箱（encase的过去分词）
be liable to stiffen容易变硬
stiffen /ˈstɪfn/vt. 使变硬；使粘稠vi. 变硬；变猛烈；变粘
sobriquet /ˈsoʊbrɪkeɪ/. 绰号
conventional /kənˈvenʃənl/adj. 符合习俗的，传统的；常见的；惯例的
haematoma /,hi:mə'təumə/n. [病理] 血肿
inhibit/ɪnˈhɪbɪt/ vt. 抑制；禁止
substitutes /'sʌbstə,tjʊt/n. 替代品；替补（substitute的复数）
impervious to water, 不透水
impervious /ɪmˈpɜːrviəs/adj. 不受影响的，无动于衷的；不能渗透的
drawback /ˈdrɔːbæk/n. 缺点，不利条件；退税
functional brace功能支具
trolley /ˈtrɑːli/n. 手推车；（美）有轨电车（等于trolley car）；（英）无轨电车（等于trolleybus）；空中吊运车
invaluable /ɪnˈvæljuəbl/adj. 无价的；非常贵重的
indispensable /ˌɪndɪˈspensəbl/n. 不可缺少之物；必不可少的人adj. 不可缺少的；绝对必要的；责无旁贷的
padded block. 垫块 /'pædid/adj. 有装填垫料的；脚底有厚肉的
Stockinette /,stɑkɪ'nɛt/n. 弹力织物；布袋；松紧织物（等于stockinet）
tuck /tʌk/vi. 缝褶裥；缩拢；
split /splɪt/n. 劈开；裂缝
百度翻译：
牵引并发症
尤其是儿童的循环窘迫，牵引带和环形绷带可能会收缩循环；因此，婴儿的腿悬挂在头顶横梁上的“绞架牵引”不应用于体重超过12公斤的儿童。
老年人神经损伤时，腿部牵引可能会诱发腓神经损伤而引起足部下垂；应反复检查肢体，看其在牵引时是否滚动成外旋。
针位感染针位必须保持清洁，并应每天检查。
铸造夹板
帕里斯石膏仍然被广泛用作夹板，特别是用于四肢远端骨折和大多数儿童骨折。只要医生对紧绷石膏的危险保持警觉，并且防止压疮，它就足够安全了。愈合的速度既不比牵引大，也不比牵引小，但病人可以早点回家。固定复位通常没有问题，胫骨骨折患者可以在石膏上承受重量。然而，用石膏包住的关节不能移动，容易变硬；僵硬是传统铸型的问题，这种僵硬导致了“骨折病”。当肿胀和血肿消退时，可能会形成粘连，使肌肉纤维相互结合并与骨结合；关节骨折时，石膏会使表面不规则现象持续存在（闭合复位很少是完美的），缺乏运动会抑制软骨缺损的愈合。较新的替代品比石膏有一些优点（它们不透水，也较轻），但只要它们作为全石膏使用，基本缺点是相同的。
可以通过以下方法将僵硬程度降至最低：（1）延迟夹板——即，使用牵引力直到运动恢复到698，然后才使用石膏；或（2）从传统石膏开始，但几周后，当四肢可以处理而不会有太多不适时，用允许关节运动的功能性支撑代替石膏。