Suture Bridge Fixation for Ulnar Sublime Tubercle Avulsion Fractures in High School Baseball Players: A Report of Two Cases

Ulnar sublime tubercle avulsion fractures caused by repetitive valgus stress are rare injuries predominantly observed in adolescent overhead throwing athletes. Although conservative management is typically the first-line treatment, surgical intervention may be required in cases of nonunion, displaced fragments, or persistent medial elbow pain. We report two high school baseball pitchers with symptomatic ulnar sublime tubercle avulsion fractures that were unresponsive to conservative treatment and were surgically treated using a suture bridge fixation technique. In both cases, the small, avulsed fragment was secured with a proximally placed suture anchor, and the suture limbs were tensioned laterally and fixed distally using a knotless anchor to achieve anatomical reduction. Radiographic bone union was confirmed at 16 and 24 weeks postoperatively, after which a progressive throwing program was initiated. Both athletes returned to full competitive pitching at 30 and 28 weeks postoperatively, respectively, without recurrence of symptoms. These cases suggest that suture bridge fixation may be a viable treatment option for adolescent athletes with ulnar sublime tubercle avulsion fractures, particularly when fragment size limits the use of screw fixation.