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Olecranon Fracture

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Olecranon fractures — patterns, non-operative care, and tension-band or plate fixation.

Updated Oct 20264 citations

An olecranon fracture is a break in the bony tip of the elbow, often after a fall onto the point of the elbow. Kieran Hirpara 4.0

What you're feeling

An olecranon fracture is a break in the bony point at the back of your elbow. It usually happens in one of two ways. In younger people it tends to follow a hard fall or a direct blow to the elbow. In older people it often comes from a simple fall from standing. A sudden, forceful straightening of the arm can also pull a piece of bone off the tip of the elbow.

You will usually feel pain right at the back of the elbow, and it tends to be sore in one spot rather than all over. Swelling over the back of the elbow is typical and can be quite marked. Because that bony point sits just under the skin, you can sometimes feel the edge of the break through the skin. If the skin was broken in the fall, the wound is usually at the back of the elbow where it hit the ground. The arm may be hard to use, and straightening it against something, like pushing up from a chair, may feel weak or impossible.

In the first days, pain is often worse when you try to move the elbow, and it can disturb your sleep. Everyday tasks that bend or load the elbow, such as lifting a kettle, dressing, or leaning on your forearm, will usually hurt. The swelling and bruising settle over the first couple of weeks, and the pain gradually eases as the bone starts to heal.

Some things need urgent care. Go to the emergency department the same day if the skin over the elbow is broken, if bone is showing, or if the arm looks obviously out of shape. The same applies if your hand or fingers turn pale, cold, white or blue, or if you suddenly lose feeling or movement in the arm after the injury. If symptoms are not settling, are getting worse over weeks, or are waking you at night, see your GP or ask for a specialist review. If you cannot reach the clinic, go to your nearest emergency department.

What's actually happening

The bony point at the back of your elbow is called the olecranon. It is the top end of one of your forearm bones, and it acts like a hinge cap. When you straighten your arm, that cap glides in a groove at the end of your upper arm bone. The break matters because of what is attached to it: the tendon from your triceps, the muscle at the back of your upper arm, is anchored right at that point. That tendon is what lets you straighten your elbow against a load.

Think of it like a door with a strong spring pulling it shut. The olecranon is the bracket holding that spring. When the bone breaks, the spring keeps pulling, and it drags the broken piece up and away, leaving a gap in the joint surface. That is why your arm does not work normally right now: the muscle is still strong, but it is pulling on a loose piece of bone instead of moving your forearm. Straightening against resistance becomes weak or impossible.

Bone heals by knitting back together, and a broken-off piece with its tendon attached can reattach as the bone knits. But the pieces need to be in the right position for that to work well. When the break has not shifted, the pieces can simply be held still while they knit. When the pieces have pulled apart, or when the joint surface is broken into several pieces, the elbow can become unstable, and those breaks usually need surgery to hold them in place while they heal.

Surgeons grade these breaks by how far the pieces have moved and whether the elbow joint stays stable. A grade one break has not shifted. A grade two has shifted but the joint still works. A grade three means the elbow joint itself is unstable. The shifted and unstable grades are the ones that most often need surgery.

Most of these breaks heal well, with a small loss of full straightening being common.

What we can do about it

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, matches the treatment to your specific injury. Some of these breaks heal without an operation, and others need surgery soon after the injury, so prompt assessment matters. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. At the clinic we take a history, examine your arm, and arrange imaging where it is needed.

If the break has not shifted, or has shifted only a little, and your elbow is stable, we may recommend holding it still while it heals. That means a splint or cast for a period, with checks on repeat X-rays to make sure the pieces stay in place. This path is common for older patients, and for people whose arm is used for everyday tasks rather than heavy work. It avoids an operation and the risks that come with one. The trade-off is that the elbow may not straighten fully at the end, and some people find that hard to accept. Movement is brought back in stages with your hand therapist, who will also make any splint you need.

If the pieces have pulled apart, or the elbow joint is unstable, we will usually recommend surgery from the start. The aim is to hold the pieces in the right position so the bone can knit and you can move early. The choice of how to hold the bone depends on the pattern of the break, and no single method suits every fracture. Sometimes both paths are genuinely open, for example in an older patient with a shifted break. We will talk through what matters to you: how much pain you are willing to put up with, and whether losing the last few degrees of straightening would bother you.

Whichever path you take, the first weeks are similar. Pain relief keeps you comfortable while the swelling settles. The injury needs protecting while the bone knits, and we will tell you what you can and cannot do with the arm. Your hand therapist will guide your movement at the right stage, gently at first, building up as the bone heals. Most of these breaks heal well, with a small loss of full straightening being common. Metalwork sitting just under the skin at the back of the elbow can be uncomfortable, and some people need a small operation later to remove it.

What to expect

Most of these breaks heal well. A small loss of full straightening is common, and most people keep good use of the arm. Long-term results after surgery for complex breaks are good, even when some wear-and-tear arthritis shows up in the joint on later X-rays.

If your break is held still in a splint or cast, the bone knits over weeks rather than days. You will have repeat X-rays to make sure the pieces stay where they should. This path suits older patients and people whose arm does everyday jobs rather than heavy work. Outcomes at both the short-term and long-term mark are satisfactory in that group. The trade-off is that the elbow may not straighten fully at the end.

If you have surgery, the bone is held in place with metal while it knits. Movement starts early and builds in stages with your hand therapist. Some loss of full straightening is expected after this injury, whichever path you take. In one long look at people treated with surgery for a shifted break, 96% had good or excellent results up to 25 years after the injury.

Recovery is a gradual return to what you normally do. Light daily tasks come back first, then lifting and heavier use as the bone strengthens. How soon you can drive, work or play sport depends on your job, your arm and how the bone heals, and we will talk you through each stage.

Things that can go wrong are worth knowing about. The metalwork sits just under the skin at the back of the elbow, and it can be uncomfortable enough that some people choose to have it removed later. That is a recurring issue after this surgery. Other problems, such as the bone healing in a poor position or the elbow staying stiff, are less common. If your symptoms are not settling, are getting worse over weeks, or are waking you at night, see your GP or ask for a specialist review. If you cannot reach the clinic, go to your nearest emergency department.

When to see someone

Seek urgent care if your elbow looks obviously out of shape, if the skin is broken over the injury, or if your hand or fingers turn pale, cold, white or blue. Sudden loss of feeling or movement in the arm after the injury also needs the emergency department the same day. These signs mean the injury needs looking at straight away.

For everything else, start with your GP. They can examine your arm and arrange X-rays, which are usually all that is needed to show this type of break. If your GP thinks a specialist should take over, they will refer you for a review.

Come back, or ask for a specialist review, if the pain is not settling, or if the swelling, movement or use of your arm are not improving week on week as the bone heals. Symptoms that are getting worse over weeks, waking you at night, or stopping you working or using the arm also deserve another look. If you cannot reach the clinic, go to your nearest emergency department.

In more depth

Advanced reading: the deeper science (optional)

This section goes further than you need for your own treatment decisions. Olecranon fracture is worth the extra reading because of one finding that inverts the usual logic of fracture surgery: in older patients, a displaced fracture of the olecranon can be left unfixed, and the elbow still works.

The displaced fracture that does not need fixing

A fracture through the olecranon separates the triceps from the forearm, so the standard reasoning is that it must be reattached or the elbow cannot be straightened against resistance. In patients older than 70, that reasoning does not hold up. A systematic review found displaced olecranon fractures in this group may be effectively managed non-operatively, producing high satisfaction and a functional range of motion [1].

What is traded is measurable: an extension lag, an inability to fully straighten the elbow, and reduced extension strength. What is avoided is a wound over a subcutaneous bone in thin, often fragile skin, and metalwork under that skin. Since prominent hardware is the commonest reason for a second operation after olecranon fixation, avoiding it removes the commonest complication entirely.

For an older person whose arm is used for daily tasks rather than forceful pushing, an elbow that lacks the last few degrees of extension is a smaller imposition than a wound complication. For a younger or higher-demand patient it is not, which is why the finding is specific to age rather than general.

Where fixation is used, the implant choice has separated

For the common displaced-but-simple pattern, two implants compete: a tension band construct of wires and a plate. Across 827 patients with Mayo type II fractures, plate fixation showed better efficacy and safety than tension band wiring, with the authors noting that few studies were included and that higher-quality randomised trials are still needed [2]. A 2025 review of 472 patients comparing modern fixation techniques against traditional tension band wiring points the same way [3].

This is one of the few places on this site where a technique comparison produces a direction rather than a shrug. It is worth holding lightly given the evidence base the authors themselves flag.

Arthritis develops, and mostly does not matter

Long-term imaging findings can be alarming when reported without context. Following isolated olecranon fractures, the median incidence of post-traumatic osteoarthritis was 19% at a median follow-up of 41 months, and final patient-reported outcomes ranged from good to excellent regardless of fracture type or the presence of arthritis [4].

Both halves of that sentence are load-bearing. Arthritis on a follow-up X-ray after this injury is common. It is also, at this timescale, largely disconnected from how people report their elbow functioning. A radiological finding is not automatically a clinical problem, and it should not be the trigger for further intervention on its own.

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Reviewed by Dr Kieran Hirpara · 7 August 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

References for the advanced reading

1. Alvara CA, Biedron G, Dunn JC. Nonoperative management of olecranon fractures in elderly patients: a systematic review. Hand (N Y). 2020;17(4):734-9.
2. Jia Y, Liu A, Guo T, Chen J, Yu W, Zhai J. Efficacy and safety of tension band wire versus plate for Mayo II olecranon fractures: a systematic review and meta-analysis. J Orthop Surg Res. 2022;17(1).
3. Wang C, Li C. Modern fixation techniques versus traditional tension band wiring for olecranon fractures: a systematic review and meta-analysis. J Orthop Surg Res. 2025;20(1).
4. Wiersma JP, de Klerk HH, Priester-Vink S, Doornberg JN, Bhasyam AR, van den Bekerom MP. Incidence of post-traumatic osteoarthritis in olecranon fractures and the role of fracture type: a systematic review. J Shoulder Elbow Surg. 2026.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

General Outcomes and Complications

• A majority of olecranon fractures heal uneventfully with good or excellent results, with a small loss of motion expected [11].
• 96% of individuals with a closed displaced fracture of the olecranon treated by open reduction and internal fixation had excellent or good outcomes up to 25 years after the fracture [4].
• Surgical treatment of olecranon fractures is associated with a high rate of complications [18].
• Patients undergoing revisions beyond implant removal after olecranon fracture fixation had poorer functional outcomes [18].
• No significant differences in functional outcomes or secondary operations were found with respect to fracture type, gender, or surgical method for olecranon fractures [18].
• The incidence of post-traumatic osteoarthritis following isolated olecranon fractures is 19% at a median follow-up of 41 months [22].

Operative Management

• No single technique is suitable for the management of all olecranon fractures [21].
• Low-profile double-plate osteosynthesis is a safe and effective alternative treatment for olecranon fractures with excellent subjective and objective clinical outcome measures [1].
• Plating of the olecranon leads to predictable union, though the most common complication was lack of full extension in 39% of patients [16].
• Both Kirschner wire tension band and anatomical locking plate procedures effectively treat Mayo type II olecranon fractures [9].
• Current randomized evidence suggests that tension band wiring and plate fixation may yield similar functional outcomes for displaced olecranon fractures, based on a limited number of randomized controlled trials [24].
• Tension band wiring remains an effective treatment for appropriately selected olecranon fractures and outperformed plate osteosynthesis in one cohort [40].
• The timing of fixation of displaced olecranon fractures does not significantly increase the rate of early complications or reoperation [15].
• Excision of the olecranon fragment with repair of the triceps mechanism is supported as a preferred method of treatment due to significantly less morbidity compared with internal fixation [65].

Non-Operative Management

• Close radiographic follow-up is recommended for nonsurgically treated olecranon fractures in children [2].
• Some isolated displaced (>2 mm) olecranon fractures in elderly patients can be successfully treated nonoperatively [6].
• Satisfactory short-term and long-term outcomes were found following the nonoperative management of isolated displaced olecranon fractures in older, lower-demand patients [13].
• Displaced olecranon fractures in patients older than 70 years may be effectively managed with nonoperative measures to produce high satisfaction and functional range of motion [23].
• Nonoperative management of olecranon fractures in elderly patients offers comparable functional outcomes to surgical intervention while significantly reducing exposure to potential complications and healthcare costs [41].
• Nonoperative treatment is a reasonable option for displaced stable olecranon fractures in elderly patients [29].

Elderly Population Specifics

• Olecranon fractures in the elderly have higher than expected 1-year mortality rates [5].
• Patients with olecranon fractures have essentially similar demographic characteristics compared to patients with distal radius fractures [10].
• The literature on the treatment of olecranon fractures in elderly patients is limited [7].

Anatomy & Pathophysiology

Bony Anatomy

• The olecranon and the coronoid process form the greater sigmoid notch, which articulates with the trochlea of the distal humerus [37].
• The intrinsic anatomy of the ulnohumeral articulation allows flexion/extension movement of the elbow joint and provides stability for the elbow [37].
• The olecranon serves as the insertion for the triceps tendon, which blends with the periosteum of the proximal ulna [37].
• The exposed, subcutaneous position of the olecranon renders it vulnerable to direct trauma and violent muscular contractions from the triceps [37].
• In children, the olecranon is predominantly cartilage, particularly in younger children, which reduces the chance of fracture occurring with a direct blow [48].
• In children, the thick periosteum and relatively thin metaphyseal cortex of the olecranon predispose it to minimally displaced greenstick fractures [48].
• Radiographic measurements of normal elbows guide the surgeon to obtain a more reliable length of the olecranon and maintain articular geometry during fixation [69].

Mechanisms of Injury

• Olecranon fractures can result from a direct blow, a fall on an outstretched hand with the elbow in flexion, or high-energy trauma associated with radial head fractures or elbow dislocation [37].
• Sudden and violent triceps muscle contraction can produce an avulsion fracture of varying size of the olecranon tip [37].
• A bimodal distribution of olecranon fractures is seen in young patients with high-energy trauma and elderly patients with low-energy trauma such as a fall from standing [37].
• Olecranon fractures typically occur as low-energy falls from standing in older patients or high-energy injury mechanisms in younger patients [38].
• The bone typically fails from a direct blow to the elbow or as a tensile force from the pull of the triceps tendon [38].
• Regardless of the mechanism of injury, the triceps acts as the main deforming mechanism pulling the fractured fragment proximally, creating a gap at the articular surface, and an incompetent extensor mechanism [38].
• In children, olecranon fractures are usually the result of a hyperextension injury [48].
• In children, flexion injuries are usually caused by a fall on an outstretched hand with the elbow flexed, resulting from a strong eccentric contraction of the triceps pulling the olecranon over the fulcrum of the distal humerus [48].
• In children, shear injuries result from a force to the proximal ulna just anterior to the humeral condyles, causing the olecranon to fracture through metaphyseal bone with anterior displacement of the distal fragment [48].
• Olecranon fractures commonly occur with a direct blow, generally resulting in comminuted fractures, or as an avulsion injury with triceps contracture [54].
• Contraction of the triceps often results in transverse or short oblique types of olecranon fractures [54].
• In children, hyperextension injuries are frequently associated with other elbow injuries, where the direction of the associated coronal plane force determines the corresponding injuries [48].
• In children, a valgus hyperextension force may produce an associated radial neck or medial epicondyle fracture [48].
• In children, a varus hyperextension injury may be associated with lateral dislocation of the radial head or a Bado type III Monteggia lesion [48].
• In children, flexion injuries are generally transverse (perpendicular to the axis of the ulna), displaced posteriorly rather than anteriorly, and rarely associated with other injuries [48].

Associated Injuries

• Olecranon fractures typically occur in isolation; however, given the subcutaneous location of the injury, there is a risk to soft tissues as well as risk of the fracture being open [38].
• In an epidemiologic study of olecranon fractures, 22% of patients had injuries to the ipsilateral limb and 6.4% of fractures were open [38].
• In children, olecranon fractures are associated with other elbow injuries (usually the medial epicondyle) in 20% to 50% of cases [48].

Classification

• The Mayo classification is the most common classification used for olecranon fractures, based on the amount of fracture displacement, the presence of comminution, and stability of the ulnohumeral joint [38].
• In the Mayo classification, Type I fractures are nondisplaced, Type II fractures are displaced, and Type III fractures have an unstable ulnohumeral joint [38].
• In the Mayo classification, modifier A indicates simple (noncomminuted) fractures and modifier B indicates comminuted fractures [38].
• The Mayo classification is simple to use, can help guide fracture management, and has good interobserver reliability [38].
• Displaced olecranon fracture lines entered along the medial side of the trochlear notch and exited at the base of the coronoid, while minimally displaced fractures entered and exited the trochlear notch at the base of the coronoid [38].
• The Schatzker and Colton classification attempted to classify olecranon fractures based on different fracture pattern morphology; however, its application was limited [38].
• A proposed fragment-specific classification system for complex olecranon fractures is anatomically based and considers the deforming forces from ligaments and tendons [64].
• In a study of 2462 fractures, the distribution included a larger share of comminuted central fractures (29%) compared to a single-center report from Scotland [8].
• In a study of 2462 fractures, an almost threefold larger share of distal olecranon fractures was observed compared to the 6.2% reported in a Scottish study of 64 olecranon fractures [8].
• In a study of 2462 fractures, the distribution differed from a single-center report from Scotland where 74% of the fractures were simple central fractures and 81% were central fractures [8].

Classification

Classification Systems and Reproducibility

• The Mayo classification is the most commonly used classification system in clinical practice for olecranon fractures [43].
• The Mayo classification consists of 3 types with a modifier to indicate comminution [43].
• Type I fractures in the Mayo classification are nondisplaced [43].
• Type II fractures in the Mayo classification are displaced [43].
• Type III fractures in the Mayo classification have accompanying injuries [43].
• The Mayo classification was designed to simplify categorization of olecranon fractures but does not achieve this goal due to poor reproducibility [27].
• Multiple classification systems for olecranon fractures exist, including AO, Mayo, Schatzker and Colton, but none are widely accepted or provide direct and reliable advice on operative strategies [88].
• The low reproducibility rates of existing olecranon fracture classification systems raise questions about their use in clinical and research contexts [88].
• The Colton classification had the best intra- and inter-observer agreement among the Mayo, AO/OTA, and Colton & Schatzker classifications [111].
• The AO classification subsumes olecranon fractures to proximal forearm injuries [88].
• Schatzker and Colton divide olecranon fractures into groups by quantity of fragments and fracture lines [88].

Fracture Morphology and Distribution

• Quantitative 3-dimensional computed tomography analysis further clarified the fracture morphology of Mayo type I, II, and III fractures [62].
• In a study of 2462 fractures from the Swedish Fracture Register, 29% of olecranon fractures were comminuted central fractures [8].
• The share of distal olecranon fractures in the Swedish Fracture Register was almost threefold larger than the 6.2% reported in a Scottish study of 64 olecranon fractures [8].
• In a study of 64 olecranon fractures, the most frequent injury according to the AO fracture classification was the 21-B1.1 type [94].
• In a study of 64 olecranon fractures, a simple isolated displaced olecranon fracture (Mayo type 2A) was the most common according to the Mayo classification [94].
• In a study of 44 patients treated with tension band wiring, Type IIA fractures were the most common pattern, accounting for 91% of cases [107].
• In a study of 57 patients treated with a shape-memory alloy concentrator, the Mayo classification system was used to distinguish fracture displacement, presence of comminution, and ulnohumeral stability [60].
• Mayo type III fractures are categorized into anterior and posterior olecranon fracture-dislocations based on the radio-ulnar relationship [106].
• Articular impaction is a common feature of geriatric olecranon fractures [32].

Pediatric and Adolescent Considerations

• Fracture of the olecranon in a child is often only part of a complex injury to the bone and soft tissues around the elbow [30].
• The olecranon apophyseal ossification system, when combined with age and sex, successfully predicts peak height velocity within a year in 90% of cases [93].

Clinical Presentation

Mechanisms and Epidemiology

• The triceps acts as the main deforming mechanism pulling the fractured fragment proximally, creating a gap at the articular surface, and an incompetent extensor mechanism [38].
• The incidence of olecranon fractures increased by 29% over a 20-year study period in Denmark [12].
• In a Swedish study of 2462 fractures, 29% were comminuted central fractures and the share of distal olecranon fractures was almost threefold larger than in a Scottish study [8].
• In a Swedish study, high-energy injury mechanisms accounted for 5.7% of female and 11.6% of male patients overall, while low-energy mechanisms accounted for 87.4% of female and 77.8% of male patients overall [8].
• Fractures of the ipsilateral olecranon associated with the radial neck are not as rare as previously reported [42].

Physical Examination

• Pain is usually localized to the posterior part of the elbow [37].
• Given the subcutaneous location of the olecranon, the fracture itself may be palpable [37].
• Extensive posterior swelling is typical [37].
• A careful examination of the integrity of the extensor mechanism with gravity eliminated can aid surgical decision making [37].
• If present, open wounds are typically posterior and result from the direct impact of the posterior surface of the elbow against an unyielding structure [37].
• The affected extremity from shoulder to hand should be thoroughly examined for any soft tissue compromise [38].
• There is a low suspicion for open fractures given the subcutaneous nature of the olecranon [38].
• The elbow will often present with a large fluid collection subcutaneously over the olecranon [38].
• Examination of the extensor mechanism both with and without gravity eliminated should be performed to assess competency [38].

Imaging

• Plain radiographs are usually sufficient for isolated fractures of the olecranon [37].
• A true lateral radiograph is necessary to accurately identify the plane of the fracture and the number of fracture fragments [37].
• The examiner should assess for fracture comminution and impaction on radiographs [37].
• In more complex cases, CT may help delineate the comminution or impaction better, but this is not routinely required [37].
• Anteroposterior and lateral radiographs of the elbow are required for olecranon fractures [38].
• If there is concern for a radial head fracture, a radiocapitellar view of the elbow can be obtained [38].
• In the setting of an elbow dislocation, post-reduction radiographs should be obtained [38].
• Computed tomography (CT) can be used for preoperative planning for comminuted fractures of the olecranon if there is an associated radial head or coronoid fracture, but this is not routinely utilized [38].

Classification

• The Mayo classification is based on the amount of fracture displacement, the presence of comminution, and stability of the ulnohumeral joint [38].
• The modifier A (simple) and B (comminuted) in the Mayo classification indicate the presence of comminution [38].
• The Schatzker and Colton classification attempted to classify olecranon fractures based on different fracture pattern morphology, but its application was limited [38].

Prognosis and Outcomes

• A majority of olecranon fractures heal uneventfully with good or excellent results with a small loss of motion to be expected [11].
• Primary elbow instability and fracture morphology are prognostic factors for elbow function and development of arthrosis after operative treatment of olecranon fractures [45].
• The median incidence of post-traumatic osteoarthritis following isolated olecranon fractures is 19% at a median follow-up of 41 months [22].
• Patients aged 50 years or more with olecranon fracture should be evaluated for osteoporosis and fracture risks for secondary prevention of subsequent fractures [36].

Investigations

Clinical Examination

• The history may help distinguish a triceps avulsion from an actual direct blow to the elbow [37].
• Extensive posterior swelling is typical of olecranon fractures [37].
• Open wounds, if present, are typically posterior and result from the direct impact of the posterior surface of the elbow against an unyielding structure [37].
• The affected extremity from shoulder to hand should be thoroughly examined to identify associated ipsilateral injuries [38].
• The arm should be examined for soft tissue compromise, with a low suspicion for open fractures maintained given the subcutaneous nature of the olecranon [38].

Imaging

• In more complex cases, CT may help delineate comminution or impaction better, though this is not routinely required [37].
• Quantitative analysis of olecranon fractures via CT further clarified fracture morphology of Mayo type I, II, and III fractures [62].

Classification

• The distribution of olecranon fractures in a Swedish register study showed a larger share of comminuted central fractures (29%) compared to a single-center report from Scotland [8].
• The Swedish register study observed an almost threefold larger share of distal olecranon fractures than the 6.2% reported in a Scottish study of 64 olecranon fractures [8].

Pediatric Specifics

• Olecranon fractures are associated with other elbow injuries (usually the medial epicondyle) in 20% to 50% of pediatric cases [48].
• In younger children, the olecranon is predominantly cartilage, which reduces the chance of a fracture occurring with a direct blow [48].
• The thick periosteum and relatively thin metaphyseal cortex of the pediatric olecranon predispose it to minimally displaced greenstick fractures [48].

Treatment

General Principles and Indications

• Conventional indications for surgical treatment of olecranon fractures include open fractures, displaced fractures, and fractures causing disruption to the extensor mechanism affecting the insertion of the triceps muscle into the olecranon [28].
• The aims of treatment for all olecranon fractures are restoration of function and stability to the elbow joint to allow early mobilization, while minimizing associated complications [113].
• Fixation must be secure enough to permit early motion to avoid significant stiffness of the elbow joint [20].
• Good results overall are to be expected after surgical management of olecranon fractures [43].

Non-Operative Management

• Mayo type I stable undisplaced fractures can be managed effectively with nonoperative management [113].
• Some authors suggest splinting the elbow in 45° to 90° of flexion for three to four weeks followed by supervised mobilization for stable undisplaced fractures [113].
• Early active mobilization is recommended where pain allows, and time in a cast should be minimized to reduce stiffness [113].
• The acceptable degree of fracture displacement for nonoperative management is commonly quoted as < 2 mm of articular displacement on the lateral radiograph [113].
• Aggregate data support the non-operative treatment of isolated undisplaced olecranon fractures in children with good results [33].
• Nonoperative management of isolated displaced olecranon fractures in older, lower-demand patients yields satisfactory short-term and long-term outcomes [13].

Operative Management: Techniques and Outcomes

• There are four common methods in the surgical management of olecranon fractures: tension band wiring, plate fixation, intramedullary fixation, and excision of the proximal fractured fragment with re-attachment of triceps tendon [28].
• Both operative procedures (Kirschner wire tension band and anatomical locking plate) effectively treat Mayo type II olecranon fractures [9].
• Current randomized evidence suggests that tension band wiring (TBW) and plate fixation (PF) may yield similar functional outcomes for displaced olecranon fractures, based on a limited number of RCTs [24].
• Among active patients with a simple isolated, displaced fracture of the olecranon, no difference was found between TBW and plate fixation in patient-reported outcome at 1 year following surgery [35].
• Plate fixation has better efficacy and safety for Mayo II olecranon fractures compared to tension band wiring [51].
• TBW remains an effective treatment for appropriately selected olecranon fractures and outperformed plate osteosynthesis in one cohort [40].
• Internal fixation by cable pin system (CPS) is associated with a shorter healing time, fewer complications, and better function than TBW [34].
• Low-profile double-plate osteosynthesis is a safe and effective alternative treatment of olecranon fractures with excellent subjective and objective clinical outcome measures [1].
• Low-profile double-plate osteosynthesis for treating olecranon fractures resulted in good clinical outcomes [85].
• Suture tension band fixation reduces hardware complications in olecranon fractures [3].
• In all patients treated with percutaneously placed K-wires and absorbable tension-band sutures for displaced olecranon fractures, fracture united within 6 weeks and full painless range of movement was regained within 6 months [47].
• Fractures through an ununited olecranon apophysis are successfully treated with plate and screw fixation with bone grafting [71].
• The Nickel-Titanium olecranon memory connector (OMC) can be an effective alternative to treat olecranon fractures [77].
• The study supports the rationale for excision of the fragment of the olecranon with repair of the triceps mechanism as the preferred method of treatment due to significantly less morbidity compared with internal fixation [65].
• Functional results after at least 2 years were equally good with tension band and screwing techniques, but there was a considerably higher rate of separation at the fracture after screwing than after inserting a tension band [46].

Complications and Risk Factors

• Patients undergoing revisions beyond implant removal had poorer functional outcomes after olecranon fracture fixation [18].
• No significant differences in functional outcomes or secondary operations were found with respect to fracture type, gender, or surgical method for olecranon fracture fixation [18].
• Patients who have operative fixation of a fracture of the olecranon can be counseled that most patients keep their implants, that only 3% experience implant migration, and that technical factors such as the type or configuration of an implant seem less important than personal factors in determining who requests a second surgery for implant removal [25].
• Risk factors associated with a poorer outcome following operative treatment of displaced olecranon fractures are patient factors, fracture morphology, and associated elbow instability or fractures [113].

Complications

General Outcomes and Mortality

• ORIF for olecranon fractures demonstrates low short-term complication rates [101].
• Specific comorbidities such as smoking and ascites were associated with increased risk of short-term complications following ORIF for olecranon fractures [101].

Hardware and Fixation Complications

• Symptomatic hardware requiring removal is a recurring and frequent problem in olecranon fracture management [43].
• The most common complication following plating of the olecranon was lack of full extension in 39% of patients [16].
• Only 3% of patients who undergo operative fixation of an olecranon fracture experience implant migration [25].
• Technical factors such as the type or configuration of an implant seem less important than personal factors in determining who requests a second surgery for implant removal [25].
• Internal fixation by cable pin system (CPS) is associated with fewer complications than tension band wiring (TBW) for olecranon fractures [34].
• Suture tension band fixation reduces hardware complications in olecranon fractures compared to traditional techniques [3].

Long-Term and Specific Complications

• Articular impaction in olecranon fractures is associated with worse postoperative outcomes [67].
• Inadequate reduction of articular impaction contributes to increased step-off and poorer function in olecranon fractures [67].

Recovery

General Outcomes

• Articular impaction in olecranon fractures is associated with worse postoperative outcomes, with inadequate impaction reduction contributing to increased step-off and poorer function [67].

Operative Recovery

• Surgical treatment of olecranon fractures is associated with a high rate of complications, and patients undergoing revisions beyond implant removal had poorer functional outcomes [18].
• No significant differences in functional outcomes or secondary operations were found with respect to fracture type, gender, or surgical method following open reduction and fixation of olecranon fractures [18].
• Both tension band wiring and plate fixation yield excellent or good clinical outcomes with minimal loss of physical capacity, little pain, and disability in the majority of patients with simple and comminuted displaced olecranon fractures [68].
• Among active patients with a simple isolated, displaced fracture of the olecranon, no difference was found between tension band wiring and plate fixation in the patient-reported outcome at 1 year following surgery [35].
• Internal fixation by cable pin system is an effective method for olecranon fracture and is associated with a shorter healing time, fewer complications, and better function than tension band wiring [34].
• Tension band wiring remains an effective treatment for appropriately selected olecranon fractures and in one cohort outperformed plate osteosynthesis [40].
• Both Kirschner wire tension band combined with anatomical locking plate and standard operative procedures effectively treat Mayo type II olecranon fractures [9].

Non-Operative Recovery

• Close radiographic follow-up for nonsurgically treated olecranon fractures is recommended due to the risk of further displacement after initial nonsurgical treatment in children [2].
• All 10 cases of olecranon fractures in children treated with a sling were free of symptoms and had a full range of elbow movement at 3 weeks [17].

Elderly-Specific Outcomes

Key Evidence

• [L3] Low-profile double-plate osteosynthesis is a safe and effective alternative treatment of olecranon fractures with excellent subjective and objective clinical outcome measures. [1] (10.1016/j.otsr.2019.08.019)
• [L4] Close radiographic follow-up for nonsurgically treated olecranon fractures is recommended. [2] (10.5435/jaaos-d-25-00821)
• [L3] Future studies should focus on the long-term outcomes of this technique, as compared to traditional and more established techniques to treat olecranon fractures. [3] (10.1016/j.jseint.2026.101734)
• [L3] 96% of individuals with a closed displaced fracture of the olecranon treated by open reduction and internal fixation had excellent or good outcomes up to 25 years after the fracture. [4] (10.1067/mse.2002.124548)
• [L3] Olecranon fractures in the elderly have higher than expected 1 year mortality rates. [5] (10.1177/1758573221994860)
• [L4] Some isolated displaced (>2 mm) olecranon fractures in elderly patients can be successfully treated nonoperatively. [6] (10.1016/j.ocl.2016.08.011)
• [L4] The literature on the treatment of olecranon fractures in elderly patients is limited. [7] (10.1007/s11678-018-0488-7)
• [L4] [8] (10.1007/s00068-021-01765-2)
• [L3] Both operative procedures effectively treat Mayo type II olecranon fractures. [9] (10.1186/s12891-025-08843-1)
• [L3] Patients with olecranon fractures have essentially similar demographic characteristics compared to patients with distal radius fractures. [10] (10.1177/17585732221124301)
• [L4] A majority of olecranon fractures heal uneventfully with good/excellent results with a small loss of motion to be expected. [11] (10.1016/j.hcl.2015.07.003)
• [L3] The incidence of olecranon fractures increased by 29% over the 20-year study period. [12] (10.1186/s13018-025-05970-2)
• [L4] We found satisfactory short-term and long-term outcomes following the nonoperative management of isolated displaced olecranon fractures in older, lower-demand patients. [13] (10.2106/jbjs.l.01137)
• [L3] The timing of fixation of displaced olecranon fractures does not significantly increase the rate of early complications or reoperation. [15] (10.1016/j.jhsg.2023.09.002)
• [L3] Plating of the olecranon leads to predictable union, though the most common complication was lack of full extension in 39% of patients. [16] (10.1016/j.injury.2016.04.015)
• [L4] All 10 cases treated with a sling were free of symptoms and had a full range of elbow movement at 3 weeks. [17] (10.1016/0020-1383(75)90056-x)
• [L4] Surgical treatment of olecranon fractures is associated with a high rate of complications, and patients undergoing revisions beyond implant removal had poorer functional outcomes; however, no significant differences in functional outcomes or secondary operations were found with respect to fracture type, gender, or surgical method. [18] (10.1016/j.xrrt.2025.08.004)
• [L5] Fixation must be secure enough to permit early motion to avoid significant stiffness of the elbow joint. [20] (10.5435/00124635-200007000-00007)
• [Paper] No one technique is suitable for the management of all olecranon fractures. [21] (10.1016/j.injury.2008.12.013)
• [L4] This review identified a median OA incidence of 19% at a median follow-up of 41 months following isolated olecranon fractures. [22] (10.1016/j.jse.2026.02.024)
• [L4] Displaced olecranon fractures in patients older than 70 years may be effectively managed with nonoperative measures to produce high satisfaction and functional range of motion. [23] (10.1177/1558944720944261)
• [L1] Current randomized evidence suggests that TBW and PF may yield similar functional outcomes for displaced olecranon fractures; however, these findings are based on a limited number of RCTs, with several secondary outcomes derived from only 2 studies. [24] (10.1016/j.xrrt.2026.100817)
• [L3] Patients who have operative fixation of a fracture of the olecranon can be counseled that most patients keep their implants, that only 3% experience implant migration, and that technical factors such as the type or configuration of an implant seem less important than personal factors in determining who requests a second surgery for implant removal. [25] (10.1007/s11999-015-4488-2)
• [L5] The Mayo classification was designed to simplify categorization of olecranon fractures but does not achieve this goal due to poor reproducibility. [27] (10.1097/corr.0000000000000614)
• [L1] [28] (10.1002/14651858.cd010144.pub2)
• [L1] This supports nonoperative treatment as a reasonable option for displaced stable olecranon fractures in elderly patients. [29] (10.2106/jbjs.24.00655)
• [L4] Fracture of the olecranon in a child is often only part of a complex injury to the bone and soft tissues around the elbow. [30] (10.1016/0020-1383(80)90009-1)
• [L4] Articular impaction is a common feature of geriatric olecranon fractures. [32] (10.5435/jaaos-d-20-01293)
• [L4] Aggregate data support the non-operative treatment of isolated undisplaced olecranon fractures with good results, and support the operative treatment of fractures displaced ≥4 mm. [33] (10.1302/2058-5241.5.190082)
• [L1] Internal fixation by CPS is an effective method for olecranon fracture and is associated with a shorter healing time, fewer complications and better function than TBW. [34] (10.1177/147323001204000324)
• [L1] Among active patients with a simple isolated, displaced fracture of the olecranon, no difference was found between TBW and plate fixation in the patient-reported outcome at 1 year following surgery. [35] (10.2106/jbjs.16.00773)
• [L4] Our results suggest that patients aged 50 years or more with olecranon fracture should be evaluated for osteoporosis and fracture risks for secondary prevention of subsequent fractures. [36] (10.11005/jbm.2017.24.3.175)
• [L4] TBW remains an effective treatment for appropriately selected olecranon fractures and in this cohort outperformed plate osteosynthesis. [40] (10.1007/s00590-015-1724-0)
• [L5] Nonoperative management of olecranon fractures in elderly patients offers comparable functional outcomes to surgical intervention while significantly reducing exposure to potential complications and healthcare costs. [41] (10.1016/j.injury.2025.112579)
• [L3] Fractures of the ipsilateral olecranon associated with the radial neck are not so rare as previously reported. [42] (10.1186/s13018-021-02373-x)
• [L4] [43] (10.1016/j.jhsa.2012.12.036)
• [L3] Primary elbow instability and fracture morphology are prognostic factors for elbow function and development of arthrosis after operative treatment of olecranon fractures. [45] (10.1016/j.injury.2003.12.002)
• [L4] [46] (10.1016/0020-1383(87)90386-x)
• [L4] In all patients, fracture was united within 6 weeks and all patients regained full painless range of movement of elbow within 6 months. [47] (10.1097/bte.0b013e318254642f)
• [L1] Plate has better efficacy and safety for Mayo II olecranon fractures. [51] (10.1186/s13018-022-03262-7)
• [L4] [60] (10.1186/s13018-020-01982-2)
• [L4] Quantitative analysis of olecranon fractures further clarified fracture morphology of Mayo type I, II, and III fractures. [62] (10.1016/j.jse.2015.10.002)
• [L4] This proposed classification system is anatomically based and considers the deforming forces from ligaments and tendons. [64] (10.1016/j.jse.2023.12.021)
• [L3] The study supports the rationale for excision of the fragment of the olecranon with repair of the triceps mechanism as the preferred method of treatment of fractures of the olecranon due to significantly less morbidity compared with internal fixation. [65] (10.2106/00004623-198163050-00005)
• [L3] Articular impaction in olecranon fractures is associated with worse postoperative outcomes, with inadequate impaction reduction contributing to increased step-off and poorer function. [67] (10.1302/0301-620x.108b1.bjj-2025-0444.r1)
• [L3] Both TBW and plate fixation yield excellent/good clinical outcomes with minimal loss of physical capacity, little pain and disability in the majority of patients with simple and comminuted displaced olecranon fractures. [68] (10.1007/s00402-014-2021-9)
• [L4] The authors conclude that these measurements guide the surgeon to obtain a more reliable length of the olecranon and maintain articular geometry during fixation. [69] (10.1002/ca.20431)
• [L5] Fractures through an ununited olecranon apophysis are successfully treated with plate and screw fixation with bone grafting. [71] (10.1142/s2424835520720017)
• [L2] The study showed that OMC could be an effective alternative to treat olecranon fractures. [77] (10.1007/s00264-013-1878-5)
• [L3] Low-profile double-plate osteosynthesis for treating olecranon fractures resulted in good clinical outcomes. [85] (10.1016/j.jse.2020.01.091)
• [L4] [88] (10.1016/j.jor.2019.09.017)
• [L3] When combined with age and sex, the olecranon system successfully predicts PHV within a year in 90% of cases, establishing a single lateral view of the olecranon as a simple alternative to more complex grading systems. [93] (10.2106/jbjs.20.01856)
• [L3] [94] (10.1016/j.injury.2011.10.017)
• [L4] ORIF for olecranon fractures demonstrates low short-term complication rates; however, specific comorbidities such as smoking and ascites were associated with increased risk. [101] (10.1016/j.jseint.2025.06.017)
• [Paper] [106] (10.1007/s00402-016-2593-7)
• [L4] [107] (10.1016/j.jhsa.2013.05.012)
• [L4] [111] (10.1016/j.injury.2024.111496)
• [L4] [113] (10.1302/0301-620x.105b2.bjj-2022-0703.r1)

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