Tscherne H, Jähne J
Unfallchirurgische Klinik, Medizinischen Hochschule Hannover.
Unfallchirurg. 1990 Apr;93(4):157-64.
The problems encountered in the treatment of fractures of the distal radius lie in the frequent redislocation even after correct reduction. The ASIF classification should be used for a fracture-oriented therapeutic approach. Therefore, only fractures that are not dislocated should be treated conservatively. The majority of fractures require closed or open reduction followed by internal fixation. Articular fractures, in particular, require precise reduction of the articular surface. Following the reduction the fractures should be stabilized, usually with Kirschner wires. The more severe fractures--especially those falling in C1-C3 according to the ASIF classification--can be adequately treated by open reduction with a dorsal or volar approach and subsequent stabilization with the T plate, most often combined with other methods of internal fixation. Open fractures and complex traumas of the upper extremity should be treated by means of a fixateur externe for 2-4 weeks, followed by a change of treatment; the basic decision is usually between internal fixation with plates and further conservative treatment alone. The relatively poor long-term results obtained with treatment of distal radial fractures require that therapeutic guidelines be elaborated for the treatment of these fractures.
桡骨远端骨折治疗中遇到的问题在于，即使复位正确，仍频繁出现再脱位。应采用AO/ASIF分类法进行以骨折为导向的治疗。因此，只有无脱位的骨折才应采用保守治疗。大多数骨折需要闭合或切开复位，然后进行内固定。特别是关节骨折，需要精确复位关节面。复位后，骨折通常要用克氏针固定。对于较严重的骨折——尤其是根据AO/ASIF分类属于C1-C3型的骨折——可采用背侧或掌侧入路切开复位，随后用T形钢板固定，多数情况下还需结合其他内固定方法。开放性骨折和上肢复杂创伤应采用外固定器治疗2-4周，然后改变治疗方法；基本的治疗选择通常是钢板内固定还是单纯进一步保守治疗。桡骨远端骨折治疗的长期效果相对较差，因此需要制定这些骨折的治疗指南。
