Jiménez-Aroche César Alejandro, Pérez de León Mishelle, Saldivar-Moreno Arturo, Hernández-Pavón Mariela
Department of Trauma, Sports Orthopedics and Arthroscopy, National Rehabilitation Institute, México City, Mexico.
Am J Case Rep. 2025 Sep 26;26:e948197. doi: 10.12659/AJCR.948197.
BACKGROUND The management of comminuted and displaced radial head fractures (Mason III), particularly when associated with dislocation (Mason IV) or Essex-Lopresti injury, presents a complex surgical challenge. Treatment options include conservative management, surgical fixation, arthroplasty, or radial head resection; however, no consensus exists regarding the optimal approach for all injury types. Radial head resection is often preferred in complex cases with multiple fragments where reconstruction is unfeasible. While functional and radiological outcomes vary widely, there is a growing trend toward the use of prosthetic implants as the initial treatment to maintain elbow function and stability, with temporary implants employed when definitive ones are unavailable. CASE REPORT We present the case of a 46-year-old patient who underwent radial head resection and received a cemented radial head spacer as temporary management due to the unavailability of a definitive implant. Functional status was monitored over a 21-month period. Our aim was to identify a readily available operating room material capable of effectively neutralizing valgus and axial forces. Since the spacer is intended as a temporary solution, it must be removed or replaced with a definitive implant approximately 4-6 months postoperatively, once stability is reestablished. Beyond this period, bone lysis has been observed. CONCLUSIONS The significance of this case report lies in highlighting alternative options for radial head replacement in complex, irreparable fractures, proposing an easily accessible solution available in any orthopedic operating room. It is further distinguished by its extended follow-up period (21 months) and by providing evidence of the long-term tolerability of cemented spacers - an aspect that has been infrequently reported.
背景 粉碎性移位桡骨头骨折（梅森Ⅲ型）的处理，尤其是合并脱位（梅森Ⅳ型）或埃克塞尔-洛普雷斯蒂损伤时，是一项复杂的外科挑战。治疗选择包括保守治疗、手术固定、关节成形术或桡骨头切除术；然而，对于所有损伤类型的最佳治疗方法尚无共识。在有多个骨折块且无法重建的复杂病例中，通常首选桡骨头切除术。虽然功能和影像学结果差异很大，但越来越倾向于使用假体植入物作为初始治疗以维持肘关节功能和稳定性，在无法获得确定性植入物时使用临时植入物。病例报告 我们报告一例46岁患者，因无法获得确定性植入物，接受了桡骨头切除术并植入了骨水泥型桡骨头间隔器作为临时治疗。在21个月的时间里对其功能状态进行了监测。我们的目的是找到一种在手术室容易获得的材料，能够有效抵消外翻和轴向力。由于间隔器是作为临时解决方案，术后约4至6个月一旦重建了稳定性，就必须取出或用确定性植入物替换。超过这个时间段，已观察到骨溶解。结论 本病例报告的意义在于强调了在复杂、无法修复的骨折中桡骨头置换的替代选择，提出了一种在任何骨科手术室都容易获得的解决方案。它还因其延长的随访期（21个月）以及提供了骨水泥型间隔器长期耐受性的证据而具有特色——这方面的报道很少见。
