Original Article

Knotless suture anchor fixation of Hahn–Steinthal fractures of the capitellum: A technical note with preliminary clinical outcomes

Department of Orthopaedics and Traumatology, University Clinical Hospital No. 2, Medical University of Łódź, Łódź, Poland

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Received: 21 March 2026
Accepted: 7 May 2026

Abstract

Background: Hahn–Steinthal fractures are rare osteochondral injuries of the humeral capitellum that primarily affect young and active patients. Although several fixation techniques have been described, most rely on metallic implants or knot-tying constructs that may increase intra-articular bulk and the risk of cartilage damage. The use of knotless suture anchor fixation for this specific fracture pattern has not yet been specifically described. To our knowledge, this study represents the first report describing knotless suture anchor fixation specifically for Hahn–Steinthal fractures of the capitellum. Methods: This study describes an open reduction and knotless suture anchor fixation technique for Hahn–Steinthal fractures of the capitellum and reports early clinical outcomes in a consecutive series of five patients treated in 2025. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) score, while pain intensity was evaluated using the Visual Analog Scale (VAS). Elbow range of motion (ROM) and radiographic fracture healing were also assessed during follow-up. Patients were followed for 12 weeks postoperatively. Results: The cohort consisted of five patients (three men and two women) with a mean age of 37 years (SD 3.5). All fractures achieved radiographic union without secondary displacement. In addition, computed tomography performed at 3 months postoperatively confirmed osseous union and restoration of articular congruity in the index case. The mean DASH score improved from 62 preoperatively to 43 at 2 weeks, 31 at 6 weeks, and 21 at 12 weeks postoperatively. Mean VAS scores decreased from 8 preoperatively to 5 at 2 weeks, 4 at 6 weeks, and 3 at 12 weeks. The mean flexion–extension arc improved from 48° (SD 5.5) preoperatively to 110° (SD 6.7) at final follow-up. No intraoperative or postoperative complications were observed during the 12-week follow-up period. Conclusions: Open reduction followed by knotless suture anchor fixation represents a technically feasible technique associated with encouraging early clinical and radiological outcomes in this preliminary case series. The absence of intra-articular metal hardware may reduce the risk of cartilage damage while allowing stable fixation of small osteochondral fragments and early functional recovery.