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我们正在精读国外经典骨科书籍《Apley’s System of Orthopaedics and Fractures》，想要对于骨科英文形成系统认识，为以后无障碍阅读英文文献打下基础，请持续关注。
MALLEOLAR FRACTURES OF THE ANKLE Fractures and fracture dislocations of the ankle are common. Most are low-energy fractures of one or both malleoli, usually caused by a twisting mechanism. Less common are the more severe fractures involving the tibial plafond, the pilon fractures, which are high-energy injuries often caused by a fall from a height. The patient usually presents with a history of a twisting injury, usually with the ankle going into inversion, followed by immediate pain, swelling and difficulty weightbearing. Bruising often comes out soon after injury. One such injury was described by Percival Pott in 1768, and the group as a whole was for a long time referred to as Pott’s fracture – although as with many eponyms, he was not the first to notice or describe it, and what became known by this eponym was not what he described anyway! The most obvious injury is a fracture of one or both malleoli; often, though, the 'invisible’ part of the injury – rupture of one or more ligaments – is just as serious. Mechanism of injury The patient stumbles and falls. Usually the foot is anchored to the ground while the body lunges forward. The ankle is twisted and the talus tilts and/or rotates forcibly in the mortise, causing a low-energy fracture of one or both malleoli, with or without associated injuries of the ligaments. If a malleolus is pushed off, it usually fractures obliquely; if it is pulled off, it fractures transversely. The precise fracture pattern is determined by: (1) the position of the foot; (2) the direction of force at the moment of injury. The foot may be either pronated or supinated and the force upon the talus is towards adduction, abduction or external rotation, or a combination of these. Pathological anatomy There is no completely satisfactory classification of ankle fractures. Lauge-Hansen (1950) grouped these injuries according to the likely position of the foot and the direction of force at the moment of fracture. This is useful as a guide to the method of reduction (reverse the pathological force); it also gives a pointer to the associated ligament injuries. However, some people find this classification overly complicated. For a detailed description the reader is referred to the original paper by Lauge-Hansen (1950). A simpler (perhaps too simple) classification is that of Danis and Weber (Müller et al., 1991), which focuses on the fibular fracture. Type A is a transverse fracture of the fibula below the tibiofibular syndesmosis, perhaps associated with an oblique or vertical fracture of the medial malleolus; this is almost certainly an adduction (or adduction and internal rotation) injury. Type B is an oblique fracture of the fibula in the sagittal plane (and therefore better seen in the lateral xray) at the level of the syndesmosis; often there is also an avulsion injury on the medial side (a torn deltoid ligament or fracture of the medial malleolus). This is probably an external rotation injury and it may be associated with a tear of the anterior tibiofibular ligament. Type C is a more severe injury, above the level of the syndesmosis, which means that the tibiofibular ligament and part of the interosseous membrane must have been torn. This is due to severe abduction or a combination of abduction and external rotation. Associated injuries are an avulsion fracture of the medial malleolus (or rupture of the medial collateral ligament), a posterior malleolar fracture and diastasis of the tibiofibular joint. 图1 踝关节骨折的Lauge-Hansen分型 A.旋后外旋（外翻）型；B.旋后内翻型；C.旋前外旋型；D.旋前外翻型 图2 踝关节骨折的Danis-Weber分型 百度文库： Danis and Weber分型https://wenku.baidu.com/view/879f70d1bceb19e8b8f6baa5.html ---from 《Apley’s System of Orthopaedics and Fractures》 重点词汇整理： lunge/lʌndʒ/v. 猛冲，猛扑；刺，戳；用驯马索训练n. 猛冲，猛扑； For a detailed description the reader is referred to the original paper by Lauge-Hansen (1950).对于详细的描述，读者可以参考劳格-汉森(1950)的原始论文。 sagittal plane矢状平面 membrane /ˈmembreɪn/n. 膜；薄膜；羊皮纸 有道翻译（仅供参考，建议自己翻译）： 踝骨折 踝关节骨折和骨折脱位是常见的。大多数是一个或两个踝关节的低能骨折，通常是由扭曲的机械引起的。较不常见的是涉及胫骨斑块的较严重骨折，pilon骨折，这是高能量损伤，通常是从高处坠落引起的。 病人通常有扭伤的病史，通常踝关节发生倒转，随后出现即刻疼痛、肿胀和举重困难。受伤后很快就会出现瘀伤。 其中一次这样的伤害是由Perciva Pott在1768年描述的，整个组长期被称为Pott骨折——尽管与许多同名的人一样，他不是第一个注意或描述它的，而这个名字所知道的并不是他所描述的！ 最明显的损伤是一个或两个踝关节骨折；然而，通常，受伤的“无形”部分——一条或多条韧带断裂——同样严重。 损伤机制 病人跌倒了。通常，脚被锚定在地面上，而身体则向上猛冲。踝关节扭曲，距骨在榫槽中用力倾斜和/或旋转，造成一个或两个踝关节的低能骨折，韧带有或无相关损伤。如果一个踝关节被推开，通常会斜骨折；如果它被拔下，它会横向断裂。精确的骨折部位由以下几个方面来确定：（1）足部的位置(2） 受伤时的力方向。脚可以是旋前或仰卧的，滑爪上的力是向内收、外展或外旋，或是这些的组合。 病理解剖学 踝关节骨折的分类尚不完全满意。LaugeHansen（1950）根据骨折时脚部的可能位置和力方向将这些损伤分组。这对指导减持方法（扭转病理力）有一定的指导意义；它还可以指向相关韧带损伤。然而，有些人发现这种分类过于复杂。有关详细说明，读者可参考LaugeHansen（1950）的原始论文。 一个简单（也许太简单）的分类是Danis和Weber（M）üLeller等人，1991年），重点研究腓骨骨折。A型是指胫腓骨联合韧带下方腓骨的横向骨折，可能与内踝的斜或垂直骨折有关；这几乎可以肯定是内收（或内收和内旋）损伤。B型是指在矢状面（因此在侧x射线中更能看到）的腓骨在同节水平上的斜骨折；通常内侧也有撕脱伤（三角肌韧带撕裂或内踝骨折）。这可能是一种外旋损伤，可能与胫腓前韧带撕裂有关。C型损伤较严重，高于粘连水平，这意味着胫腓韧带和部分骨间膜必须被撕裂。这是由于严重绑架或绑架和外部旋转的结合。相关损伤是指内踝撕脱骨折（或内侧副韧带断裂）、踝后骨折和胫腓关节松解。 |
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