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NERVE INJURY Nerve injury is particularly common with fractures of the humerus or injuries around the elbow or the knee (see also Chapter 11). The telltale signs should be looked for (and documented) during the initial examination and again after reduction of the fracture. Closed nerve injuries In closed injuries the nerve is seldom severed, and spontaneous recovery should be awaited – it occurs in 90 percent within 4 months. If recovery has not occurred by the expected time, and if nerve conduction studies and EMG fail to show evidence of recovery, the nerve should be explored. Open nerve injuries With open fractures the nerve injury is more likely to be complete. In these cases the nerve should be explored at the time of debridement and repaired at the time or at wound closure. Acute nerve compression Nerve compression, as distinct from a direct injury, sometimes occurs with fractures or dislocations around the wrist. Complaints of numbness or paraesthesia in the distribution of the median or ulnar nerves should be taken seriously and the patient monitored closely; if there is no improvement within 48 hours of fracture reduction or splitting of bandages around the splint, the nerve should be explored and decompressed. ---from 《Apley’s System of Orthopaedics and Fractures》P712-713 重点词汇整理： The telltale signs 迹象；指征 documented /ˈdɑːkjuməntɪd/adj. 备有证明文件的;记录 severe /sɪˈvɪr/adj. 严峻的；严厉的；剧烈的；苛刻的 severedv. 断绝；分离（sever的过去分词）；割下adj. 切断的；隔断的 EMG 肌电图（Electromyography） /i,lektrəumai'ɔɡrəfi/ distinct/dɪˈstɪŋkt/adj. 不同的；明显的；独特的；清楚的；有区别的 median or ulnar nerves 正中神经或尺神经 Nerve compression神经压迫 decompressed.解除压迫 splitting of bandages around the splint,解开夹板周围绷带 split /splɪt/n. 劈开；裂缝adj. 劈开的 vt. 分离；使分离；劈开；离开；分解vi. 离开；被劈开；断绝关系 splint /splɪnt/n. 夹板；薄木条；薄金属片vt. 用夹板固定 百度翻译： 神经损伤 神经损伤尤其常见于肱骨骨折或肘部或膝盖周围的损伤（另见第11章）。在初次检查和骨折复位后，应寻找（并记录）信号。 闭合性神经损伤 在闭合性损伤中，神经很少被切断，应等待自然恢复——在4个月内，90%的神经会恢复。如果在预期的时间内没有恢复，如果神经传导研究和肌电图没有显示恢复的迹象，就应该探查神经。 开放性神经损伤 对于开放性骨折，神经损伤更可能是完全的。在这些情况下，神经应在清创时探查，并在伤口闭合时修复。 急性神经压迫 神经压迫，有别于直接损伤，有时发生在手腕周围的骨折或脱位。对正中神经或尺神经分布麻木或感觉异常的投诉应予以重视，并密切监视病人；如果骨折复位或夹板周围绷带断裂后48小时内没有改善，应探查神经并减压。 |
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