General treatment is the first consideration: treat the patient, not only the fracture. The principles are discussed in Chapter 22.
Treatment of the fracture consists of manipulation to improve the position of the fragments, followed by splintage to hold them together until they unite; meanwhile joint movement and function must be preserved. Fracture healing is promoted by physiological loading of the bone, so muscle activity and early weightbearing are encouraged. These objectives are covered by three simple injunctions:
Two existential problems have to be overcome. The first is how to hold a fracture adequately and yet permit the patient to use the limb sufficiently; this is a conflict (Hold versus Move) that the surgeon seeks to resolve as rapidly as possible (e.g. by internal fixation). However the surgeon also wants to avoid unnecessary risks – here is a second conflict (Speed versus Safety). This dual conflict epitomizes the four factors that dominate fracture management (the term ‘fracture quartet’ seems appropriate).
The fact that the fracture is closed (and not open) is no cause for complacency. The most important factor in determining the natural tendency to heal is the state of the surrounding soft tissues and the local blood supply. Low-energy (or low-velocity) fractures cause only moderate soft-tissue damage; high-energy (velocity) fractures cause severe soft-tissue damage, no matter whether the fracture is open or closed.
Tscherne (Oestern and Tscherne, 1984) has devised a helpful classification of closed injuries:
• Grade 0 – a simple fracture with little or no softtissue injury.
• Grade 1 – a fracture with superficial abrasion or bruising of the skin and subcutaneous tissue.
• Grade 2 – a more severe fracture with deep softtissue contusion and swelling.
• Grade 3 – a severe injury with marked soft-tissue damage and a threatened compartment syndrome.
The more severe grades of injury are more likely to require some form of mechanical fixation; good skeletal stability aids soft-tissue recovery.
---from 《Apley’s System of Orthopaedics and Fractures》P695
splintage/'splintidʒ/n. [医] 夹板固定
Fracture healing is promoted by physiological loading of the bone.骨折愈合是由骨的生理负荷促进的
injunctions: [管理] 禁令（injunction的复数）；指令；警告
internal fixation 骨折内固定术
quartet /kwɔːrˈtet/n. 四重奏；四重唱；四件一套
the state of the surrounding soft tissues and the local blood supply周围软组织和局部血液供应的状态
velocity /vəˈlɑːsəti/n. 【物】速度
a helpful classification of closed injuries闭合性损伤的一个有用的分类