Hahn-Steinthal fracture: a case report
© Nawghare et al; licensee BioMed Central Ltd. 2008
Received: 23 July 2008
Accepted: 15 October 2008
Published: 15 October 2008
Isolated fracture of the capitellum is rare. We present clinical and radiological data on a single case of a fracture of capitellum. We came across a 31 year old woman who sustained an isolated Hahn Steinthal type of fracture. It was treated operatively by open reduction and internal fixation using mini fragment screws. The elbow was immobilized for 4 weeks. The patient regained full range of movement at 12 weeks post operatively. We reiterate that anatomical reduction and fixation is the right way to treat this injury.
Fracture of the capitellum is uncommon. Since fracture of the capitellum is rare, most of the information in the available literature is based on only a few cases. They account for 6% of distal humerus fractures [1–3]. We present a case of a 31 year old woman who presented with a Type I (Hahn-Steinthal) fracture of the capitellum. The fracture was treated by open reduction and internal fixation. The result of this form of management was found to be satisfactory.
The first description of capitellar fracture was put forth by Hahn  and Steinthal  in the 19th century. This fracture is more common in individuals older than 12 years and very rare in children. A fall on the outstretched hand or directly on the elbow produces a shear force fracturing the capitellum in the coronal plane. As the center of rotation of the capitellum is 12–15 mm anterior to the humeral shaft, it is vulnerable to the shear forces. These fractures can be classified according to the McKee modification of the Bryan and Morrey classification. [2, 7] Type I (Hahn-Steinthal) is a coronal shear fracture with a large osseous capitellar fragment [4, 5] Type II involves a shell of the articular cartilage with a thin layer of bone and are known by the eponym Kocher-Lorenz [8, 9]. Type III fractures include all comminuted fractures of the capitellum.  McKee et al added a fourth pattern, noting that in some cases the Hahn-Steinthal[4, 5] fracture extends medially in the coronal plane to include the lateral half of the trochlea. There is no universal agreement on the treatment of this fracture. Closed reduction of type I has been advocated . It can be treated surgically by open reduction and internal fixation using minifragment standard screw set, Kirschner wires (K-wires), small/minifragment Herbert screws, absorbable pins, compression screws, staples and bone pegs. The treatment of type II & III involves excision of the of the fragments as fixation is not feasible. Isolated fracture of capitellum is indeed a rare injury. The treatment of the fracture is still controversial. There is no randomized controlled trial available to direct the correct line of management. Working along the good principles of fracture management, we reduced the fracture after exposing it and fixed it with mini fragment screws. We conclude that reconfiguring the anatomical exactness is perhaps the best form of treatment for the Hahn Steinthal fracture. To this effect, fixing the fracture with mini fragment screws after open reduction is definitely the way forward. Although we used the mini fragment screws for fixation, we agree that any form of fixation which helps reconstruct the anatomy perfectly is acceptable.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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