骨科英文书籍精读（119）

SMITH’S FRACTURE

Smith (a Dubliner, like Colles) described a similar fracture about 20 years later. However, in this injury the distal fragment is displaced anteriorly (which is why it is sometimes called a ‘reversed Colles’). It is caused by a fall on the back of the hand.

Clinical features

The patient presents with a wrist injury, but there is no dinner-fork deformity. Instead, there is a ‘garden spade’ deformity.

X-ray There is a fracture through the distal radial metaphysis; a lateral view shows that the distal fragment is displaced and tilted anteriorly – the opposite of a Colles’ fracture. The entire metaphysis can be fractured, or there can be an oblique fracture exiting at the dorsal or volar rim of the radius.

Treatment

The fracture is reduced by traction, supination and extension of the wrist, and the forearm is immobilized in a cast for 6 weeks. X-rays should be taken at 7–10 days to ensure the fracture has not slipped. Unstable fractures should be fixed with percutaneous wires or a plate.

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

重点词汇整理：

spade /speɪd/n. 铁锹，铲子；（扑克牌中的）黑桃v. 铲；把……弄实抹平

dorsal背侧

volar掌侧 /ˈvoʊlər/adj. 手掌的，足底的；属于飞行的

supination /,sju:pi'neiʃən/n. 旋后；反掌姿势

percutaneous /ˌpɜːrkjuːˈteɪniəs/adj. 经皮的；经由皮肤的

百度翻译：

史密斯骨折

史密斯（Dubliner，和科莱斯一样）在20年后描述了一个类似的骨折。然而，在这种损伤中，远端的碎片向前移位（这就是为什么它有时被称为“反向Colles”）。这是由于手背摔了一跤造成的。

临床特点

但叉子并没有伤及患者的手腕。相反，有一个'花园铲'畸形。

X线显示桡骨远端干骺端骨折，侧位显示远端骨块移位并向前倾斜，与Colles骨折相反。整个干骺端可以骨折，也可以在桡骨背缘或掌侧缘出现斜向骨折。

治疗

骨折通过牵引、旋后和腕关节的伸展而减少，前臂固定在石膏中6周。应在7-10天进行X光检查，以确保骨折没有滑脱。不稳定骨折应用经皮钢丝或钢板固定。

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