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我們正在精讀國外經典骨科書籍《Apley’s System of Orthopaedics and Fractures》，想要對于骨科英文形成系統認識，為以后無障礙閱讀英文文獻打下基礎，請持續關注。
ANKLE FRACTURES IN CHILDREN Physeal injuries are quite common in children and almost a third of these occur around the ankle. Mechanism of injury The foot is fixed to the ground or trapped in a crevice and the leg twists to one or the other side. The tibial (or fibular) physis is wrenched apart, usually resulting in a Salter–Harris type 1 or 2 fracture. With severe external rotation or abduction the fibula may also fracture more proximally. The tibial metaphyseal spike may come off posteriorly, laterally or posteromedially; its position is determined by the mechanism of injury and suggests the method of reduction. With adduction injuries the tip of the fibula may be avulsed. Type 3 and 4 fractures are uncommon. They are due to a supination–adduction force. The epiphysis is split vertically and one piece of the epiphysis (usually the medial part) may be displaced. Two unusual injuries of the growing ankle are the Tillaux fracture and the notorious triplane fracture. The Tillaux fracture is an avulsion of a fragment of tibia by the anterior tibiofibular ligament; in the child or adolescent this fragment is the lateral part of the epiphysis and the injury is therefore a Salter–Harris type 3 fracture. The triplane fracture occurs on the medial side of the tibia and is a combination of Salter–Harris types 2 and 3 injuries. Fracture lines appear in the coronal, sagittal and transverse planes. Injury to the physis may result in either asymmetrical growth or arrested growth. Clinical features Following a sprain the ankle is painful, swollen, bruised and acutely tender. There may be an obvious deformity, but sometimes the injury looks deceptively mild. Imaging Undisplaced physeal fractures – especially those in the distal fibula – are easily missed. Even a hint of physeal widening should be regarded with great suspicion and the child x-rayed again after 1 week. In an infant the state of the physis can sometimes only be guessed at, but a few weeks after injury there may be extensive periosteal new bone formation. In triplane fractures the tibial epiphysis may be split in one plane and the metaphysis in another, thus making it difficult to see both fractures in the same x-ray. CT scans are particularly helpful in these and other type 3 injuries. ---from 《Apley’s System of Orthopaedics and Fractures》 重點詞匯整理： Physeal生長的;骺板 Physeal injuries骺板損傷 crevice/?krev?s/n. 裂縫；裂隙 wrench /rent?/n. 扳手，扳鉗；扭傷；痛苦；歪曲；猛扭vt. 扭傷； metaphyseal干骺端的 adduction內收 abduction外展 supination–adduction 旋后內收 coronal, sagittal and transverse planes冠狀面，矢狀面和橫切面 asymmetrical growth or arrested growth.不對稱生長或生長停滯 asymmetrical /,es?'metr?kl/adj. 非對稱的；不勻稱的，不對等的 deceptively /d??sept?vli/adv. 看似； hint /h?nt/n. 暗示；線索vt. 暗示；示意 epiphysis /i'pifisis/n. 骺；腦上體；松果體 有道翻譯（僅供參考，建議自己翻譯）： 兒童踝關節骨折 Physeal損傷在兒童中很常見，其中近三分之一發生在腳踝周圍。 損傷機制 腳固定在地上或陷在縫隙中，腿向一側或另一側扭曲。脛骨（或腓骨）被扭開，通常導致Salter-Harris 1型或2型骨折。嚴重的外旋或外展也可能導致腓骨近端骨折。脛骨干骺突可從后、側或后內側脫落；其位置由損傷機制決定，并建議復位方法。內收傷可導致腓骨尖撕脫。 3型和4型骨折并不常見。他們是由于旋后-內收力。骨骺垂直分裂，一塊骨骺（通常是內側部分）可能移位。 兩個不尋常的受傷的增長踝關節是蒂勞克斯骨折和臭名昭著的三平面骨折。蒂勞克斯骨折是脛骨前脛腓韌帶撕裂傷；在兒童或青少年中，該骨折塊是骨骺的外側部分，因此損傷為Salter-Harris 3型骨折。 三平面骨折發生在脛骨內側，是Salter-Harris 2型和3型損傷的組合。骨折線出現在冠狀面、矢狀面和橫切面。身體損傷可能導致不對稱生長或生長停滯。 臨床特征 扭傷后腳踝疼痛，腫脹，瘀傷和劇烈疼痛。可能有明顯的畸形，但有時損傷看起來似乎很輕微。 成像 未移位的physeal骨折——尤其是腓骨遠端的骨折——很容易被遺漏。即使是肺動脈瘤擴大的跡象也應引起高度懷疑，孩子在1周后再次接受x光檢查。嬰兒的身體狀況有時只能猜測，但在受傷后幾周，可能會有廣泛的骨膜新骨形成。 在三平面骨折中，脛骨骨骺可能在一個平面上分裂，干骺端在另一個平面上分裂，因此很難在同一張x光片上同時看到兩處骨折。CT掃描對這些和其他3型損傷尤其有用。 |
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