Lacroix H, Jacobs P B, Keeman J N
Neth J Surg. 1987 Apr;39(2):59-64.
The results of operative treatment of unstable distal radial fractures were evaluated in 46 patients according to the criteria of Steinmann and Spier. The overall results were excellent or good in 35 patients (76.1%) and fair in 11 patients (23.9%). There were no poor results. Intra-articular fractures with volar dislocation (Smith type II) and fractures with severe comminution (Sarmiento type IV) are unstable and require surgery. Special attention must be paid to the Sarmiento type-II fracture with severe comminution of the dorsal cortex, severe radial shortening (greater than 10 mm) and dorsal tilt (greater than 25 degrees). Although not intra-articular, this fracture type may also prove to be unstable. The treatment of a Smith type-II fracture is a volar buttress plate unless extended comminution is present. Then, and in all other unstable fracture types, external fixation should be employed. In cases with severe loss of the dorsal cortex, bone grafting may be indicated.
根据施泰曼（Steinmann）和斯皮尔（Spier）的标准，对46例桡骨远端不稳定骨折的手术治疗结果进行了评估。35例患者（76.1%）的总体结果为优或良，11例患者（23.9%）为可。没有差的结果。伴有掌侧脱位的关节内骨折（史密斯II型）和严重粉碎性骨折（萨米恩托IV型）是不稳定的，需要手术治疗。必须特别注意萨米恩托II型骨折，其背侧皮质严重粉碎、桡骨严重短缩（大于10毫米）和背侧倾斜（大于25度）。虽然该骨折类型不是关节内骨折，但也可能是不稳定的。史密斯II型骨折的治疗方法是使用掌侧支撑钢板，除非存在广泛粉碎。对于这种情况以及所有其他不稳定骨折类型，应采用外固定。在背侧皮质严重缺失的情况下，可能需要进行植骨。
