ADULTS

Unless the fragments are in close apposition, reduction is difficult and re-displacement in the cast almost invariable. So predictable is this outcome that most surgeons opt for open reduction and internal fixation from the outset. The fragments are held by interfragmentary compression with plates and screws. Bone grafting is

advisable if there is comminution. The deep fascia is left open to prevent a build-up of pressure in the muscle compartments, and only the skin is sutured.

After the operation the arm is kept elevated until the swelling subsides, and during this period active exercises of the hand are encouraged. If the fracture is not comminuted and the patient is reliable, early range of movement exercises are commenced but lifting and sports are avoided. It takes 8–12 weeks for the bones to unite. With comminuted fractures or unreliable patients, immobilization in plaster is safer.

OPEN FRACTURES

Open fractures of the forearm must be managed meticulously. Antibiotics and tetanus prophylaxis are given as soon as possible; the wounds are copiously washed and nerve function and circulation are checked. At operation the wounds are excised and extended and the bone ends are exposed and thoroughly cleaned. The fractures are primarily fixed with compression screws and plates; if the wounds are absolutely clean, the soft tissues can be closed. If bone grafting is necessary, this is best deferred until the wounds are healed. If there is major soft-tissue loss, the bones are better stabilized by external fixation.The aim is to obtain skin cover as soon as possible; if plastic surgery services are available, these should be enlisted from the outset.

If there is any question of a compartment syndrome, the wounds should be left open and closed 24–48 hours later, with a skin graft if needed.

---from 《Apley’s System of Orthopaedics and Fractures》

重點(diǎn)詞匯整理：

from the outset從一開始

fascia /?fe???/n. 招牌,；[醫(yī)] 筋膜；繃帶；飾帶

subside/s?b?sa?d/vi. 平息,；減弱；沉淀,；坐下

meticulously /m??t?kj?l?sli/adv. 細(xì)致地,；一絲不茍地；拘泥地

 tetanus prophylaxis破傷風(fēng)預(yù)防

 /?tetn?s/n. [內(nèi)科] 破傷風(fēng),；強(qiáng)直

 /?pro?f??l?ks?s/n. [醫(yī)] 預(yù)防,；預(yù)防法

copiously/'k?upi?sli/adv. 充裕地；豐富地

defer /d??f??r/vt. 使推遲,；使延期vi. 推遲,；延期,；服從

百度翻譯：

成人

除非碎片緊密地并置，否則很難還原,，鑄件中的再置換幾乎是可變的,。這種結(jié)果是可以預(yù)見的，大多數(shù)sur  geons從一開始就選擇切開復(fù)位和內(nèi)固定,。這些碎片是用鋼板和螺絲釘通過膈間壓縮來固定的,。骨移植是

如果有粉碎，建議使用,。深筋膜是開放的,，以防止壓力積聚在肌肉室，只有皮膚是縫合,。

手術(shù)后手臂保持抬高直到腫脹消退,，在此期間鼓勵手部的積極鍛煉。如果骨折不粉碎且患者可靠,，則應(yīng)盡早進(jìn)行運(yùn)動訓(xùn)練,，但應(yīng)避免提舉和運(yùn)動。骨頭需要8-12周才能愈合,。對于粉碎性骨折或無法愈合的患者,，石膏固定更安全。

開放性骨折

前臂開放性骨折必須精心處理,。盡快給予抗生素和破傷風(fēng)預(yù)防,，充分清洗傷口，檢查神經(jīng)功能和循環(huán),。在手術(shù)中,，傷口被切除并延伸，骨端暴露并徹底清潔,。骨折主要用加壓螺釘和鋼板固定,；如果傷口絕對干凈，軟組織可以閉合,。如果需要植骨,，最好推遲到傷口愈合。如果有大面積的軟組織丟失,，骨骼可以更好地通過外部來穩(wěn)定固定,。那個目的是盡快獲得皮膚覆蓋；如果整形外科服務(wù)可用,，則從一開始就應(yīng)該爭取這些服務(wù),。

如果有任何室間綜合征的問題，傷口應(yīng)在24-48小時后開放閉合，必要時進(jìn)行植皮,。