DRESSING AND SPLINTAGE

The wound is covered with a single layer of paraffin gauze and ample wool roll. A light plaster slab holds the wrist and hand in the position of safety (wrist extended, metacarpo-phalangeal joints flexed to 90 degrees, interphalangeal joints straight, thumb abducted). This is the position in which the metacarpo-phalangeal and interphalangeal ligaments are fully stretched and fibrosis therefore least likely to cause contractures. Failure to appreciate this point is the commonest cause of irrecoverable stiffness after injury (see Fig 16.26).

This position is modified in two circumstances. (1) After primary flexor tendon suture, the wrist is held with a dorsal splint in about 20 degrees of flexion to take tension off the repair (too much wrist flexion

invites wrist stiffness and carpal tunnel symptoms) but the interphalangeal joints must remain straight. There should be minimal restriction at the front of the fingers, otherwise the resistance can precipitate rupture of the tendon. (2) After extensor tendon repair, the

metacarpo-phalangeal joints are flexed to only about 30 degrees so that there is less tension on the repair; the wrist is extended to 30 degrees and the interphalangeal joints remain straight.

---from 《Apley’s System of Orthopaedics and Fractures》

重點(diǎn)詞匯整理：

 layer /?le??r/n. 層，層次

paraffin /?p?r?f?n/n. 石蠟；[有化] 鏈烷烴；硬石蠟vt. 用石蠟處理；涂石蠟于…

gauze /ɡ??z/n. 紗布；薄紗；薄霧

fibrosis  /fa??bro?s?s/n. [醫(yī)] 纖維化，[病理] 纖維變性

contracture /k?n?tr?kt??r/n. [醫(yī)] 攣縮

 appreciate美 /??pri??ie?t/vi. 增值；漲價(jià)vt. 欣賞；感激；領(lǐng)會(huì)；鑒別

dorsal /?d??rsl/adj. （魚或動(dòng)物）背部的

precipitate /pr??s?p?te?t/v. 使（壞事等）突然發(fā)生；使突然陷入（某種狀態(tài)）；使沉淀；猛拋，猛地落下；冷凝成為雨或雪等adj. 魯莽的，倉促的；突如其來的；猛地落下的n. 沉淀物

百度翻譯：

敷料和夾板固定

傷口上覆蓋著一層石蠟紗布和充足的羊毛卷。一塊輕石膏板將手腕和手保持在安全位置（手腕伸直，掌骨指骨關(guān)節(jié)彎曲90度，指間關(guān)節(jié)伸直，拇指外展）。這是掌指骨和指間韌帶完全伸展的位置，因此纖維化最不可能引起攣縮。未能意識(shí)到這一點(diǎn)是造成受傷后無法恢復(fù)僵硬的最常見原因（見圖16.26）。

這一立場在兩種情況下被修改。（1） 初級(jí)屈肌腱縫合后，用背夾板固定手腕約20度的屈曲，以消除修復(fù)時(shí)的張力（手腕過度彎曲引起腕關(guān)節(jié)僵硬和腕管癥狀），但指間關(guān)節(jié)必須保持伸直。在鰭條前部應(yīng)該有最小限度的限制，否則阻力會(huì)導(dǎo)致肌腱斷裂。（2） 伸肌腱修復(fù)后掌骨指骨關(guān)節(jié)僅彎曲約30度，因此修復(fù)時(shí)張力較??；手腕伸展至30度，指間關(guān)節(jié)保持筆直。