骨科英文书籍精读（19）｜骨折内固定技术
INTERNAL FIXATION
Bone fragments may be fixed with screws, a metal plate held by screws, a long intramedullary rod or nail (with or without locking screws), circumferential bands or a combination of these methods.
Properly applied, internal fixation holds a fracture securely so that movement can begin at once; with early movement the ‘fracture disease’ (stiffness and oedema) is abolished. As far as speed is concerned, the patient can leave hospital as soon as the wound is healed, but he must remember that, even though the bone moves in one piece, the fracture is not united – it is merely held by a metal bridge and unprotected weightbearing is, for some time, unsafe.
The greatest danger, however, is sepsis; if infection supervenes, all the manifest advantages of internal fixation (precise reduction, immediate stability and early movement) may be lost. The risk of infection depends upon: (1) the patient – devitalized tissues, a dirty
wound and an unfit patient are all dangerous; (2) the surgeon – thorough training, a high degree of surgical dexterity and adequate assistance are all essential and (3) the facilities – a guaranteed aseptic routine, a full range of implants and staff familiar with their use are all indispensable.
Indications
Internal fixation is often the most desirable form of treatment. The chief indications are:
1. Fractures that cannot be reduced except by operation.
2. Fractures that are inherently unstable and prone to re-displace after reduction (e.g. mid-shaft fractures of the forearm and some displaced ankle fractures). Also included are those fractures liable to be pulled apart by muscle action (e.g. transverse fracture of the patella or olecranon).
3. Fractures that unite poorly and slowly, principally fractures of the femoral neck.
4. Pathological fractures in which bone disease may prevent healing.
5. Multiple fractures where early fixation (by either internal or external fixation) reduces the risk of general complications and late multisystem organ failure (Pape et al., 2005; Roberts et al., 2005).
6. Fractures in patients who present nursing difficulties (paraplegics, those with multiple injuries and the very elderly).
---from 《Apley’s System of Orthopaedics and Fractures》P700-701
重点词汇整理：
intramedullary rod or nail 髓内棒或髓内钉
intramedullary /,intrə,me'dʌləri/
adj. [解剖] 髓内的
circumferential /sɚ,kʌmfə'rɛnʃəl/adj. 圆周的
stiffness and oedema僵硬和水肿
oedema /ɪˈdiːmə/n. [病理] 水肿
sepsis /ˈsepsɪs/n. 败血症；感染
supervenes /ˌsuːpərˈviːn/v. （尤指意外）发生并带来重大影响；随后发生；由另一事实导致
manifest /ˈmænɪfest/货单；旅客名单；v. 表明，清楚显示adv. 明显地adj. 显然的，明显的
devitalized tissues坏死组织
devitalized/di'vaɪtl,aɪz/v. （使）失去生命，衰弱
dexterity /dekˈsterəti/n. 灵巧；敏捷；机敏
aseptic /ˌeɪˈseptɪk/n. [助剂] 防腐剂adj. 无菌的；防腐性的
a full range of implants and staff familiar with their use are all indispensable.一系列的植入物和熟悉其使用的工作人员都是必不可少的。
Indications /ˌɪndəˈkeʃənz/n. 适应症，显示；
desirable /dɪˈzaɪərəbl/n. 称心如意的东西，合意的人，好的品质adj. 可取的，值得拥有的
inherently unstable内在的不稳定性；本来就不稳定
mid-shaft fractures of the forearm and some displaced ankle fractures前臂中轴骨折和部分移位的踝关节骨折
patella or olecranon髌骨或鹰嘴
olecranon/o'lɛkrənɑn/n. [解剖] 鹰嘴（肘部的骨性隆起）
femoral neck.股骨颈
Pathological fractures 病理骨折
paraplegics, /ˌpærəˈpliːdʒɪk/n. 截瘫病人，下身麻痹患者adj. 截瘫的，下身瘫痪的
百度翻译：
内固定
骨碎片可以用螺钉、螺钉固定的金属板、长的髓内棒或钉（带或不带锁紧螺钉）、环形带或这些方法的组合来固定。
正确的应用，内固定牢固地固定骨折，以便可以立即开始运动；随着早期运动，“骨折病”（僵硬和水肿）被消除。就速度而言，只要伤口愈合，病人就可以出院，但他必须记住，即使骨头是一块一块地移动，骨折也不会愈合——它只是由一个金属桥支撑，在一段时间内，没有保护的负重是不安全的。
然而，最大的危险是败血症；如果感染再次发生，内部固定（精确复位、立即稳定和早期移动）的所有明显优势都可能丧失。感染的风险取决于：（1）患者-失活的组织，脏的
伤口和不合适的病人都是危险的；（2）外科医生——彻底的培训、高度的外科灵活性和充分的协助都是必不可少的；（3）设施——有保证的无菌程序、全方位的植入物和熟悉其使用的工作人员都是必不可少的。
适应症
内固定往往是最理想的治疗形式。主要迹象是：
一。除手术外不能复位的骨折。
2。骨折本身不稳定，复位后易移位（例如前臂中轴骨折和一些移位的踝关节骨折）。也包括那些容易被肌肉活动拉断的骨折（例如髌骨或鹰嘴的横向骨折）。
三。骨折愈合不良且缓慢，主要是股骨颈骨折。
四。病理性骨折，骨疾病可能阻止愈合。
5个。早期固定（内固定或外固定）可降低一般并发症和晚期多系统器官衰竭风险的多发性骨折（Pape等人，2005年；Roberts等人，2005年）。
6。出现护理困难的患者（截瘫、多发伤和高龄患者）骨折。