我們正在精讀國外經典骨科書籍《Apley’s System of Orthopaedics and Fractures》，想要對於骨科英文形成系統認識，為以後無障礙閱讀英文文獻打下基礎，請持續關注。
獲取本書全本內容>請掃描文末二維碼，關注公眾號並回復「骨折肌肉學」。
Bennett’s fracture-dislocation
This fracture, too, occurs at the base of the first metacarpal bone and is commonly due to punching; however the fracture is oblique, extends into the CMC joint and is unstable.
The thumb looks short and the carpo-metacarpal region swollen. X-rays show that a small triangular fragment has remained in contact with the medial edge of the trapezium, while the remainder of the thumb has subluxated proximally, pulled upon by the abductor pollicis longus tendon.
Treatment
It is widely supposed (with little evidence) that perfect reduction is essential. It should, however, be attempted and can usually be achieved by pulling on the thumb, abducting it and extending it. Reduction can then be held in one of two ways: plaster or internal fixation.
Plaster may be applied with a felt pad over the fracture, and the first metacarpal held abducted and extended (usually best achieved by flexing the MCP joint). However, plaster only works if it is applied with great skill, and the pressure required to maintain a reduction can cause skin damage; it has, therefore, generally been abandoned in favour of surgery.
Surgical fixation is achieved by passing a K-wire across the metacarpal base into the carpus. If the fragment is large and cannot be reduced and held with a wire, then open reduction and fixation with a lag screw is effective.
ROLANDO』S FRACTURE
This is an intra-articular comminuted fracture of the base of the first metacarpal with a T or Y configuration. Closed reduction and K-wiring or open reduction and plate fixation can be used. With more severe comminution, external fixation is needed.
---from 《Apley’s System of Orthopaedics and Fractures》
重點詞彙整理：
trapezium /trəˈpiːziəm/n. 大多角骨
remainder /rɪˈmeɪndər/n. [數] 餘數，殘餘；剩餘物；其餘的人adj. 剩餘的；吃剩的
abductor pollicis longus tendon拇長展肌腱
felt pad 毛氈坐墊；棉墊；毛氈墊板
felt /felt/n. 氈，毛氈；氈製品
it has, therefore, generally been abandoned in favour of surgery.因此，手術已普遍代替石膏固定。
in favour of 支持，贊成
intra-articular comminuted fracture關節內粉碎性骨折
configuration /kənˌfɪɡjəˈreɪʃn/n. 配置；結構；外形
百度翻譯：
貝內特骨折脫位
這種骨折也發生在第一掌骨的底部，通常是由於打孔造成的；但是骨折是傾斜的，延伸到CMC關節並且不穩定。
拇指短，腕掌區腫脹。X光片顯示，一個小的三角形碎片仍與梯形的內側邊緣接觸，而拇指的其餘部分在拇長展肌肌腱的牽引下近端半脫位。
治療
人們普遍認為（幾乎沒有證據）完全還原是必要的。但是，應該嘗試，通常可以通過拉拇指、外展拇指和伸展拇指來實現。復位可採用兩種方法之一：石膏或內固定。
石膏可以用毛氈墊敷在骨折處，第一掌骨外展並伸展（通常最好通過彎曲MCP關節來實現）。然而，膏藥只有在運用技巧高超的情況下才能發揮作用，而維持減量所需的壓力會導致皮膚損傷；因此，一般情況下，為了手術而放棄了石膏。
手術固定是通過一根K-線穿過掌骨基底進入腕關節來實現的。如果碎片較大，不能用鋼絲固定，則切開復位並用拉力螺釘固定是有效的。
羅蘭多骨折
第一掌骨基底關節內粉碎性骨折，呈T形或Y形。可採用閉合復位K-接線或開放復位鋼板固定。粉碎程度越重，需要外固定。
獲取本書全本內容>掃描以下二維碼，關注公眾號並回復「骨折肌肉學」。