骨科英文书籍精读（9）｜骨折的形态研究
SPECIAL IMAGING
Sometimes the fracture – or the full extent of the fracture – is not apparent on the plain x-ray. Computed tomography may be helpful in lesions of the spine or for complex joint fractures; indeed, these crosssectional images are essential for accurate visualization of fractures in ‘difficult’ sites such as the calcaneum or acetabulum. Magnetic resonance imaging may be the only way of showing whether a fractured vertebra is threatening to compress the spinal cord. Radioisotope scanning is helpful in diagnosing a suspected stress fracture or other undisplaced fractures.
DESCRIPTION
Diagnosing a fracture is not enough; the surgeon should picture it (and describe it) with its properties: (1) Is it open or closed? (2) Which bone is broken, and where? (3) Has it involved a joint surface? (4) What is the shape of the break? (5) Is it stable or unstable? (6) Is it a high-energy or a low-energy injury? And last but not least (7) who is the person with the injury? In short, the examiner must learn to recognize what has been aptly described as the ‘personality’ of the fracture.
Shape of the fracture
A transverse fracture is slow to join because the area of contact is small; if the broken surfaces are accurately apposed, however, the fracture is stable on compression. A spiral fracture joins more rapidly (because the contact area is large) but is not stable on compression. Comminuted fractures are often slow to join because: (1) they are associated with more severe softtissue damage and (2) they are likely to be unstable.
Displacement
For every fracture, three components must be assessed:
1. Shift or translation – backwards, forwards, sideways, or longitudinally with impaction or overlap.
2. Tilt or angulation – sideways, backwards or forwards.
3. Twist or rotation – in any direction.
A problem often arises in the description of angulation. ‘Anterior angulation’ could mean that the apex of the angle points anteriorly or that the distal fragment is tilted anteriorly: in this text it is always the latter meaning that is intended (‘anterior tilt of the distal fragment’ is probably clearer).
---from 《Apley’s System of Orthopaedics and Fractures》P693-694
重点词汇整理：
plain x-ray. 普通X线
plain /pleɪn/n. 平原；无格式；朴实无华的东西adj. 平的；简单的；朴素的；清晰的adv. 清楚地；平易地
Computed tomography （CT）计算机断层扫描 /təˈmɑːɡrəfi/n. X线断层摄影术
crosssectional 横断面
visualization /ˌvɪʒuələˈzeɪʃn/n. 形象化；清楚地呈现在心
calcaneum or acetabulum 跟骨或髋臼
Magnetic resonance imaging（MRI）磁共振成象
resonance /ˈrezənəns/n. [力] 共振；共鸣；反响
whether a fractured vertebra is threatening to compress the spinal cord. 脊椎骨折是否有压迫脊髓的危险。
Radioisotope scanning is helpful in diagnosing a suspected stress fracture or other undisplaced fractures.放射性同位素扫描有助于诊断疑似应力性骨折或其他非移位性骨折。
Radioisotope /ˌreɪdioʊˈaɪsətoʊp/n. [核] 放射性同位素
property /ˈprɑːpərti/n.特性， 性质，性能；财产；所有权
joint surface 关节面
aptly /ˈæptli/adv. 适宜地；适当地
personality /ˌpɜːrsəˈnæləti/n. 个性；品格；名人
A transverse fracture is slow to join because the area of contact is small.由于接触面积小，横向骨折不易愈合
the broken surfaces are accurately apposed但如果断裂面准确对位（吻合）
Shift or translation – backwards, forwards, sideways, or longitudinally with impaction or overlap.移位或平移-向后、向前、侧移或纵移，有撞击或重叠。
Tilt /tɪlt/n. 倾斜；
arise /əˈraɪz/vi. 出现；上升；起立
apex /ˈeɪpeks/n. 顶点；尖端
百度翻译：
特殊成像
有时在平片上看不到骨折或骨折的全部范围。计算机断层扫描可能有助于脊柱损伤或复杂关节骨折；事实上，这些横截面图像对于精确显示“困难”部位（如跟骨或髋臼）的骨折至关重要。磁共振成像可能是显示骨折椎体是否有压迫脊髓的危险的唯一方法。放射性同位素扫描有助于诊断疑似应力性骨折或其他未移位骨折。
说明
仅仅诊断一个骨折是不够的；外科医生应该用它的特性来描述它：（1）它是开放的还是闭合的？（2） 哪根骨头断了，在哪里？（3） 是否涉及关节面？（4） 断裂的形状是什么？（5） 它是稳定的还是不稳定的？（6） 是高能伤还是低能伤？最后但不是最不重要的（7）谁是受伤的人？简而言之，考官必须学会识别被恰当描述为骨折的“个性”。
骨折形态
横向断裂由于接触面积小而连接缓慢；但是，如果断裂面精确对齐，则在压缩时断裂是稳定的。螺旋形断裂连接得更快（因为接触面积大），但在压缩时不稳定。粉碎性骨折通常愈合缓慢，因为：（1）它们与更严重的软组织损伤有关，（2）它们可能不稳定。
取代
对于每个骨折，必须评估三个组成部分：
一。移位或平移-向后、向前、侧向或纵向有碰撞或重叠。
2。倾斜或成角-侧向、向后或向前。
三。扭曲或旋转-在任何方向。
在描述角度时经常会出现一个问题。“前角”可能意味着角的顶点指向前方，或远端碎片倾斜前方：在本文中，始终是后一种含义（远端碎片的前倾可能更清楚）。