CLINICAL FEATURES
HISTORY
There is usually a history of injury, followed by inability to use the injured limb – but beware! The fracture is not always at the site of the injury: a blow to the knee may fracture the patella, femoral condyles, shaft of the femur or even acetabulum. The patient’s age and mechanism of injury are important. If a fracture occurs with trivial trauma, suspect a pathological lesion. Pain, bruising and swelling are common symptoms but they do not distinguish a fracture from a soft-tissue injury. Deformity is much more suggestive.
Always enquire about symptoms of associated injuries: pain and swelling elsewhere (it is a common mistake to get distracted by the main injury, particularly if it is severe), numbness or loss of movement, skin pallor or cyanosis, blood in the urine, abdominal pain, difficulty with breathing or transient loss of consciousness.
Once the acute emergency has been dealt with, ask about previous injuries, or any other musculoskeletal abnormality that might cause confusion when the x-ray is seen. Finally, a general medical history is important, in preparation for anaesthesia or operation.
GENERAL SIGNS
Unless it is obvious from the history that the patient has sustained a localized and fairly modest injury, priority must be given to dealing with the general effects of trauma (see Chapter 22). Follow the ABCs: look for, and if necessary attend to, Airway obstruction, Breathing problems, Circulatory problems and Cervical spine injury. During the secondary survey it will also be necessary to exclude other previously unsuspected injuries and to be alert to any possible predisposing cause (such as Paget’s disease or a metastasis).
LOCAL SIGNS
Injured tissues must be handled gently. To elicit crepitus or abnormal movement is unnecessarily painful; x-ray diagnosis is more reliable. Nevertheless the familiar headings of clinical examination should always be considered, or damage to arteries, nerves and ligaments may be overlooked. A systematic approach is always helpful:
· Examine the most obviously injured part.
· Test for artery and nerve damage.
· Look for associated injuries in the region.
· Look for associated injuries in distant parts.
---from 《Apley’s System of Orthopaedics and Fractures》P692-693
重点词汇整理：
patella/pəˈtelə/n. [解剖] 髌骨
femoral condyles 股骨髁 /'kɑndəl/n. 骨节
acetabulum /,æsə'tæbjʊləm/n. [解剖] 髋臼
trivial trauma微不足道的创伤
/ˈtrɪviəl/adj. 不重要的，琐碎的；琐细的
lesion /ˈliːʒn/n. 损害；身体上的伤害；机能障碍
bruising and swelling瘀青和肿胀
bruising /ˈbruːzɪŋ/n. 挫伤；擦伤
bruise /bruːz/ v. 挫伤；擦伤
/ˈswelɪŋ/n. 肿胀，肿块；膨胀
Deformity is much more suggestive.畸形更能说明问题。/səˈdʒestɪv/adj. 暗示的；提示的；影射的
get distracted by the main injury被主要的伤害分散注意力
numbness/ˈnʌmnəs/n. 麻木；麻痹
skin pallor or cyanosis皮肤苍白或发绀
/ˈpælər/n. 苍白（尤指脸色）；青白；灰白
/,saɪə'nosɪs/n. 【医学】发绀，青紫
transient loss of consciousness.短暂的意识丧失
/ˈtrænʃnt/n. 瞬变现象；过往旅客；候鸟adj. 短暂的；路过的
anaesthesia /ˌænəsˈθiːʒə/n. 麻醉；麻木；感觉缺失（等于anesthesia）
the patient has sustained a localized and fairly modest injury病人受的是局部的、相当轻微的伤
Airway obstruction,气道阻塞
Cervical spine injury.颈椎受伤。
During the secondary survey it will also be necessary to exclude other previously unsuspected injuries and to be alert to any possible predisposing cause 在再次评估阶段，还必须排除以前未被怀疑的其他伤害，并对任何可能的诱发原因保持警惕
predisposing /,pridɪs'poz/v. 使倾向于；容易诱发
gently /ˈdʒentli/adv. 轻轻地；温柔地，温和地
To elicit crepitus or abnormal movement is unnecessarily painful引发骨擦音或异常运动是不必要的痛苦
Nevertheless尽管如此
overlooked. 忽略；不理会；宽恕
百度翻译：
临床特征
历史
通常会有受伤的病史，之后是无法使用受伤的肢体，但要小心！骨折并不总是发生在受伤的部位：对膝盖的一击可能会导致髌骨、股骨髁、股骨干甚至髋臼骨折。患者的年龄和损伤机制很重要。如果骨折伴有轻微创伤，应怀疑是病理性损伤。疼痛、瘀伤和肿胀是常见的症状，但它们不能区分骨折和软组织损伤。畸形更具暗示性。
总是询问相关伤害的症状：其他地方的疼痛和肿胀（主要伤害是一个常见的错误，尤其是严重的伤害）、麻木或失去运动、皮肤苍白或发绀、尿中有血、腹痛、呼吸困难或暂时失去意识。
一旦紧急情况得到处理，询问以前的损伤，或任何其他肌肉骨骼的异常，当看到x光时可能会引起混乱。最后，一般病史是im-692重要，为麻醉或手术做准备。
一般标志
除非从病史上可以明显看出患者遭受了局部和相当轻微的损伤，否则必须优先处理创伤的一般影响（见第22章）。遵循ABCs：寻找并在必要时处理气道阻塞、呼吸问题、循环问题和颈椎损伤。在二次调查期间，还必须排除其他先前未预料到的损伤，并警惕任何可能的诱因（如佩吉特病或转移）。
当地标志
受伤的组织必须轻拿轻放。引起crepitus或异常运动是不必要的疼痛；x线诊断更可靠。然而，临床检查中应经常考虑熟悉的头部，否则可能会忽略对动脉、神经和韧带的损伤。系统的方法总是有帮助的：
·检查最明显的受伤部位。
·动脉和神经损伤测试。
·在该区域寻找相关伤害。
·在远处寻找相关伤害。
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