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Olecranon Fracture

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

74 citationsUpdated Oct 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Olecranon fractures generally heal uneventfully with good or excellent results, though a small loss of motion is expected [12]. No single technique is suitable for the management of all olecranon fractures [23]. While surgical treatment is associated with a high rate of complications [128], 96% of individuals with a closed displaced fracture treated by open reduction and internal fixation had excellent or good outcomes up to 25 years after the fracture [3]. The timing of fixation for displaced fractures does not significantly increase the rate of early complications or reoperation [21].

In elderly patients, the literature is limited [9], but data support primary non-operative management of isolated displaced fractures [14]. Non-operative treatment in patients aged ≥75 years provided excellent functional results at 6 months without associated complications [1], and satisfactory short-term and long-term outcomes were found in older, lower-demand patients [17]. For children, close radiographic follow-up is recommended for nonsurgically treated olecranon fractures [6].

Surgical options include tension-band wiring, which remains effective for appropriately selected fractures and outperformed plate osteosynthesis in one cohort [61]. Suture fixation is the mainstay for simple olecranon fractures, with no re-operations or wound complications observed in one series [71]. Plate fixation is an effective option for displaced fractures with a good functional outcome and low complication incidence [16], leading to predictable union, though lack of full extension occurred in 39% of patients [25]. Low-profile double-plate osteosynthesis [4] and the Locking Compression Plate [5] also result in good long-term outcomes. Both Kirschner wire tension band and anatomical locking plate procedures effectively treat Mayo type II fractures [11]. For less than 5% of all fractures, a bent plate is a practical alternative [13]. Excision of the fragment with repair of the triceps mechanism was supported as a preferred method due to significantly less morbidity compared with internal fixation in one study [136]. Patients undergoing revisions beyond implant removal had poorer functional outcomes [128], although no significant differences in functional outcomes or secondary operations were found with respect to fracture type, gender, or surgical method [128].

Anatomy & Pathophysiology

Bony Anatomy

The olecranon and coronoid process form the greater sigmoid notch, which articulates with the trochlea of the distal humerus [35]. This intrinsic ulnohumeral articulation permits flexion and extension while providing joint stability [35]. The olecranon serves as the insertion site for the triceps tendon, which blends with the periosteum of the proximal ulna [35]. Its exposed, subcutaneous position renders the olecranon vulnerable to direct trauma and violent muscular contractions from the triceps [35]. In children, the olecranon is predominantly cartilage, particularly in younger patients, which reduces the likelihood of fracture from a direct blow [47]. The thick periosteum and relatively thin metaphyseal cortex of the pediatric olecranon predispose it to minimally displaced greenstick fractures [47].

Mechanisms of Injury

Olecranon fractures result from direct blows, falls on an outstretched hand with the elbow in flexion, or high-energy trauma associated with radial head fractures or elbow dislocation [35]. Sudden, violent triceps contraction can produce an avulsion fracture of varying size at the olecranon tip [35]. A bimodal distribution exists, with high-energy trauma in young patients and low-energy trauma, such as falls from standing, in elderly patients [35]. In older patients, fractures typically occur from low-energy falls from standing, while younger patients sustain injuries from high-energy mechanisms [36]. The bone typically fails from a direct blow to the elbow or as a tensile force from the pull of the triceps tendon [36]. Regardless of the mechanism, the triceps acts as the main deforming force, pulling the fractured fragment proximally to create a gap at the articular surface and an incompetent extensor mechanism [36].

In adults, olecranon fractures commonly occur with a direct blow, generally resulting in comminuted fractures, or as an avulsion injury with triceps contracture [54]. Triceps contraction often results in transverse or short oblique fracture types [54]. A flexion-extension "arc of injury" relates fracture types to the elbow position at the moment of impact [89].

In pediatric patients, olecranon fractures are usually the result of a hyperextension injury [47]. Other mechanisms include a direct blow to the flexed elbow, hyperflexion injury, or shear force [47]. Valgus hyperextension forces may produce an associated radial neck or medial epicondyle fracture [47]. Varus hyperextension injuries may be associated with lateral dislocation of the radial head or a Bado type III Monteggia lesion [47]. Flexion injuries are usually caused by a fall on an outstretched hand with the elbow flexed, resulting from strong eccentric contraction of the triceps [47]. These pediatric flexion injuries are generally transverse, displaced posteriorly rather than anteriorly, and rarely associated with other injuries [47]. 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 [47].

Associated Injuries

Olecranon fractures typically occur in isolation, but the subcutaneous location creates a risk to soft tissues and a risk of the fracture being open [36]. In an epidemiologic study, 22% of patients had injuries to the ipsilateral limb and 6.4% of fractures were open [36]. In pediatric patients, olecranon fractures are associated with other elbow injuries, usually the medial epicondyle, in 20% to 50% of cases [47]. Concurrent ipsilateral carpal and elbow injuries are rare and represent a severe injury to the upper limb caused by a longitudinal force vector of considerable magnitude [93].

Classification

The Mayo classification is the most common system used for olecranon fractures, based on fracture displacement, comminution, and ulnohumeral joint stability [36]. Type I fractures are nondisplaced, Type II fractures are displaced, and Type III fractures have an unstable ulnohumeral joint [36]. The modifier A indicates simple fractures and B indicates comminuted fractures [36]. The Mayo classification is simple to use, helps guide management, and has good interobserver reliability [36]. Displaced olecranon fracture lines enter along the medial side of the trochlear notch and exit at the base of the coronoid, while minimally displaced fractures enter and exit the trochlear notch at the base of the coronoid [36]. The Schatzker and Colton classification attempted to categorize fractures based on pattern morphology, but its application was limited [36].

In a study of 2462 fractures from the Swedish Fracture Register, 29% were comminuted central fractures, a larger share than the 74% simple central fractures reported in a single-center Scottish study [10]. The Swedish Fracture Register observed an almost threefold larger share of distal olecranon fractures compared to the 6.2% reported in a Scottish study of 64 olecranon fractures [10]. In the Swedish Fracture Register, low-energy mechanisms accounted for 87.4% of injuries in females and 77.8% in males, while high-energy mechanisms accounted for 5.7% in females and 11.6% in males [10].

Classification

Classification Systems

Mayo: The Mayo classification is the most commonly used system for olecranon fractures in clinical practice [44]. It consists of three types with a modifier to indicate comminution [44]. Type I fractures are nondisplaced and stable [44, 33]. Type II fractures are displaced but stable [44, 33]. Type III fractures are displaced, unstable, and have accompanying injuries [44, 33]. Each type is subdivided into subtype A (non-comminuted) or B (comminuted) [33]. The system specifically accounts for fracture stability and comminution [33]. However, the Mayo classification was designed to simplify categorization but does not achieve this goal due to poor reproducibility [48].

Schatzker: The Schatzker classification consists of six types based on fracture pattern: transverse, transverse impacted, oblique, comminuted, oblique distal, and fracture dislocation [129].

AO/OTA: The AO classification divides olecranon fractures into two groups: intra-articular and extra-articular [129].

Colton: The Colton classification provides treatment options based on the fracture line (avulsion, transverse, comminuted) and whether the elbow is dislocated [129]. Among the Mayo, AO/OTA, and Colton & Schatzker classifications, the Colton classification had the best intra- and inter-observer agreement [145].

Horne and Tanzer: The Horne and Tanzer classification describes three types of oblique or transverse fractures located at different thirds of the olecranon [129]. This system is less frequently used nowadays [129].

Other Considerations: Multiple classification systems for olecranon fractures exist, including AO, Mayo, Schatzker, and Colton [123]. None of the AO, Mayo, Schatzker, and Colton classification systems are widely accepted or provide direct and reliable advice on operative strategies [123]. The low reproducibility rates of these systems raise questions about their use in clinical and research contexts [123]. The five most common olecranon fracture classification systems (Mayo, Schatzker, AO, Colton, Horne and Tanzer) do not inform surgical planning or reduction strategy [129]. The reliability of these five systems has been questioned [129]. They may be useful for simple 2-part olecranon fractures but are not precise enough for complex multifragmentary fractures [129]. Current elbow fracture dislocation classification systems only describe one element of the injury or only include one pattern [64].

Epidemiology and Fracture Patterns

In a study of 2462 fractures, high-energy injury accounted for 5.7% of female and 11.6% of male patients overall, while low-energy injury accounted for 87.4% of female and 77.8% of male patients overall [10]. The distribution of olecranon fractures in a Swedish study included a larger share of comminuted central fractures (29%) compared to a single-center report from Scotland [10]. The Swedish study observed an almost threefold larger share of distal olecranon fractures than the 6.2% reported in a Scottish study of 64 olecranon fractures [10]. In a study of 64 olecranon fractures, the most frequent injury according to the AO fracture classification was the 21-B1.1 type [132]. In the same cohort, a simple isolated displaced olecranon fracture (Mayo type 2A) was the most common according to the Mayo classification [132]. Quantitative analysis of olecranon fractures further clarified fracture morphology of Mayo type I, II, and III fractures [113].

Olecranon fractures in children are usually undisplaced and incomplete [26]. The 'longitudinal split' fracture is not uncommon in children with olecranon fractures [26]. Fracture of the olecranon in a child is often only part of a complex injury to the bone and soft tissues around the elbow [31]. Articular impaction is a common feature of geriatric olecranon fractures [38].

Clinical Presentation

Mechanisms and Epidemiology

Olecranon fractures exhibit a bimodal distribution, occurring in young patients via high-energy trauma and in elderly patients through low-energy mechanisms such as falls from standing [35, 36]. In a Swedish cohort of 2462 fractures, low-energy mechanisms accounted for 87.4% of injuries in females and 77.8% in males [10]. The triceps muscle acts as the primary deforming force; sudden, violent contraction can avulse the olecranon tip, while the muscle pulls fractured fragments proximally, creating an articular gap and an incompetent extensor mechanism [35, 36]. Epidemiological data indicate a 29% increase in incidence in Denmark between 1999 and 2018 [15]. Fracture patterns vary by region; in the Swedish study, 29% were comminuted central fractures, and distal olecranon fractures were almost threefold more common than the 6.2% reported in a Scottish study [10]. Patients with olecranon fractures share demographic characteristics with those sustaining distal radius fractures [24]. Notably, elderly patients with these injuries face higher-than-expected one-year mortality rates [30].

Physical Examination

Pain is typically localized to the posterior elbow, accompanied by extensive posterior swelling and a large subcutaneous fluid collection over the olecranon [35, 36]. Due to the subcutaneous location of the bone, the fracture itself is often palpable [35]. Open wounds, when present, are typically posterior and result from direct impact against an unyielding structure [35]. A thorough examination of the extremity from shoulder to hand is required to assess soft tissue compromise, maintaining a low suspicion for open fractures given the anatomy [36]. Assessment of the extensor mechanism is critical for surgical decision-making; this involves testing integrity both with and without gravity eliminated to determine competency [35, 36].

Imaging and Classification

Plain radiographs are usually sufficient for isolated olecranon fractures, requiring anteroposterior and lateral views [35, 36]. A true lateral radiograph is necessary to accurately identify the fracture plane and fragment count [35]. The examiner must assess for comminution and impaction on these films [35]. If a radial head fracture is suspected, a radiocapitellar view should be obtained, and post-reduction radiographs are required in the setting of elbow dislocation [36]. Computed tomography (CT) is not routinely required but may aid preoperative planning for comminuted fractures with associated radial head or coronoid involvement [35, 36]. The Mayo classification system categorizes fractures based on displacement, comminution, and ulnohumeral joint stability [36]. Fracture line orientation varies with displacement: displaced fractures enter the medial side of the trochlear notch and exit at the base of the coronoid, whereas minimally displaced fractures enter and exit at the base of the coronoid [36]. In pediatric populations, fractures are usually undisplaced and incomplete, with longitudinal split patterns being not uncommon [26]. Additionally, ipsilateral olecranon fractures associated with radial neck injuries are less rare than previously reported [43].

Investigations

Plain radiography: Radiographic evaluation generally analyzes the fracture based on the percentage of articular surface involved in the fractured proximal fragment [54]. The amount of comminution, fracture angle, intraarticular step-off, degree of displacement, and patient comorbidities and functional demands are critical in evaluating the injury and selecting treatment [54]. Detailed radiological assessment of the fracture pattern is vital to understand the mechanism of injury, allowing clinicians to predict associated capsuloligamentous injury and help guide management decisions [156].

Physical Examination: The history may help distinguish a triceps avulsion from an actual direct blow to the elbow [35]. Pain usually is localized to the posterior part of the elbow [35]. If present, open wounds are typically posterior and result from the direct impact of the posterior surface of the elbow against an unyielding structure [35]. The affected extremity from shoulder to hand should be thoroughly examined [36]. The arm should be examined for any soft tissue compromise, and one should have a low suspicion for open fractures given the subcutaneous nature of the olecranon [36]. The elbow will often present with a large fluid collection subcutaneously over the olecranon [36].

Other Considerations: The Mayo classification is the most common classification used for olecranon fractures [36]. The Colton classification system can aid in decision making regarding treatment options [35].

Treatment

Non-Operative

Non-operative management is a viable option for isolated displaced olecranon fractures in elderly and lower-demand patients, offering comparable functional outcomes to surgical intervention while reducing exposure to complications and healthcare costs [98]. In patients aged ≥75 years, non-operative treatment provides excellent functional results at 6 months without associated complications [1]. Displaced fractures in patients older than 70 years may be effectively managed with nonoperative measures to produce high satisfaction and functional range of motion [42]. This approach is supported for isolated displaced fractures in the elderly [14] and can result in reasonable range of motion, minimal pain, and maintenance of extension against gravity in medically unwell patients [115]. Nonoperative management of Mayo Type II fractures may be successful, extending the age range for which such treatment of displaced olecranon fractures can be considered [34]. Patients who present with a non-union after a displaced olecranon fracture managed non-operatively have reasonable elbow function and uncommonly request operative treatment [41]. The SOFIE trial protocol aims to test for superiority of operative treatment versus non-operative treatment for displaced olecranon fractures in the elderly by comparing pain and function up to one year after injury [27]. The SOFIE trial screened 94 patients with displaced olecranon fractures, of whom 76 were deemed eligible and 64 agreed to participate [59]. In the SOFIE trial, 29 patients were randomized to the operative group and 35 were allocated to the nonoperative group [59]. The SOFIE trial results did not definitively settle the debate about managing olecranon fractures nonoperatively in patients over 75 but offered data for personalized treatment plans [18]. Close radiographic follow-up is recommended for nonsurgically treated olecranon fractures in children due to the risk of further displacement [6].

Operative

Indications: The majority of olecranon fractures are treated surgically [44]. Surgical management remains the standard of care for displaced olecranon fractures until more convincing evidence supports nonsurgical treatment, according to authors of a 2013 review who acknowledged nonsurgical management was limited to nondisplaced fractures due to editorial constraints [88]. Olecranon fractures have good to excellent outcomes with adherence to a treatment algorithm based on displacement, comminution, and joint stability [69].

Surgical Approach / Technique: No one technique is suitable for the management of all olecranon fractures [23]. Fixation must be secure enough to permit early motion to avoid significant stiffness of the elbow joint [22]. In cases with concomitant injuries, the risk of limited elbow motion is high [57].

Implant Selection: Tension band wiring (TBW) remains an effective treatment for appropriately selected olecranon fractures and outperformed plate osteosynthesis in one cohort [61]. Double tension band wiring (DTBW) produced good clinical and radiological outcomes and provides additional stability through a second TBW [60]. Internal fixation by cable pin system (CPS) is associated with a shorter healing time, fewer complications, and better function than tension band wiring (TBW) [40]. Suture tension band fixation reduces hardware complications in olecranon fractures compared to traditional techniques, though future studies should focus on long-term outcomes [2]. In a retrospective review of 48 patients, functional results after at least 2 years were equally good with tension band technique and screwing, but there was a considerably higher rate of separation at the fracture after screwing than after inserting a tension band [46]. The technical quality of fixation was open to criticism in half of the cases in both the tension band and screwing groups in a retrospective review of 48 patients [46]. Low-profile double-plate osteosynthesis for treating olecranon fractures resulted in good clinical outcomes [114]. The treatment of olecranon fractures with the use of the Locking Compression Plate (LCP) results in good long-term outcome [5]. Plate fixation of complex olecranon fracture is an effective, reliable method of treatment with low risk of non-union [66]. Plate has better efficacy and safety for Mayo II olecranon fractures compared to tension band wire [51]. In cases with concomitant injuries, the risk of limited elbow motion is high when treated with open reduction and plate osteosynthesis [57]. Both operative procedures (Kirschner wire tension band and anatomical locking plate) effectively treat Mayo type II olecranon fractures [11]. Suture anchor fixation of displaced olecranon fractures resulted in excellent midterm functional outcomes [19]. Both locking-plate osteosynthesis and intramedullary nailing could be appropriate surgical techniques for fixation of selected olecranon fractures and osteotomies [62]. The clinical role of locked intramedullary nail (IMN) fixation for the treatment of olecranon fractures and olecranon osteotomies needs to be defined by controlled, randomized prospective trials [68]. The Attenborough springs and Rush nail method provides a quick, safe, and effective method of fixing olecranon fractures and appears to give a high level of patient satisfaction [106]. The Nickel-Titanium olecranon memory connector (OMC) could be an effective alternative to treat olecranon fractures [86]. Open reduction and internal fixation with percutaneously placed K-wires and absorbable tension-band sutures is recommended for displaced transverse or oblique fractures of the olecranon in children [72].

Complications and Outcomes: Good results overall are to be expected after surgical management of olecranon fractures [44]. A majority of olecranon fractures heal uneventfully with good or excellent results, with a small loss of motion to be expected [12]. Although some loss of range of motion is common, good results overall are to be expected after surgical management [44]. Symptomatic hardware requiring removal is a recurring and frequent problem in olecranon fracture treatment [44]. In a case of non-union of a fracture of the olecranon, the patient was treated 26 years after injury [7].

Complications

Hardware-related complications: Symptomatic hardware requiring removal is a recurring and frequent problem following surgical management of olecranon fractures [44]. Patients undergoing operative fixation can be counseled that only 3% experience implant migration [146]. 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 [146].

Fixation-specific outcomes: Internal fixation by cable pin system is associated with fewer complications than tension band wiring [40]. Plate fixation for displaced olecranon fractures is associated with a low incidence of complications [16]. Suture tension band fixation reduces hardware complications in olecranon fractures compared to traditional techniques [2]. Suture fixation for simple olecranon fractures resulted in no re-operations or wound complications observed in the reported series [71].

Non-operative management: Close radiographic follow-up for nonsurgically treated olecranon fractures is recommended due to the risk of further displacement after initial nonsurgical treatment of minimally displaced fractures in children [6].

Long-term prognosis: A majority of olecranon fractures heal uneventfully with good/excellent results with a small loss of motion to be expected [12].

Recovery

General Outcomes: Good functional long-term results are to be expected in patients with complex olecranon fractures treated with open reduction and internal fixation, despite arthritic changes in the elbow joint [94].

Operative Treatment: Internal fixation by Cable Pin System (CPS) is an effective method for olecranon fracture and is associated with a shorter healing time, fewer complications and better function than Tension Band Wiring (TBW) [40]. 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 [154].

Non-Operative Treatment: Satisfactory short-term and long-term outcomes were found following the nonoperative management of isolated displaced olecranon fractures in older, lower-demand patients [17]. Close radiographic follow-up for nonsurgically treated olecranon fractures is recommended [6].

Complications and Long-Term Sequelae: The incidence of ulnohumeral osteoarthritis following isolated olecranon fractures was assessed using the Broberg and Morrey classification, where grade 1 or higher is considered to have OA [33].

Key Evidence

• [L4] Non-operative treatment of olecranon fracture in patients aged ≥75 years provided excellent functional results at 6 months, without associated complications. [1] (10.1016/j.otsr.2017.10.015)
• [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. [2] (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. [3] (10.1067/mse.2002.124548)
• [L3] Low-profile double-plate osteosynthesis is a safe and effective alternative treatment of olecranon fractures with excellent subjective and objective clinical outcome measures. [4] (10.1016/j.otsr.2019.08.019)
• [L4] The treatment of olecranon fractures with the use of the LCP results in good long-term outcome. [5] (10.1016/s0020-1383(12)70083-9)
• [L4] Close radiographic follow-up for nonsurgically treated olecranon fractures is recommended. [6] (10.5435/jaaos-d-25-00821)
• [L5] In this case of non-union of a fracture of the olecranon, the patient was treated 26 years after injury. [7] (10.1016/0020-1383(87)90296-8)
• [L4] Some isolated displaced (>2 mm) olecranon fractures in elderly patients can be successfully treated nonoperatively. [8] (10.1016/j.ocl.2016.08.011)
• [L4] The literature on the treatment of olecranon fractures in elderly patients is limited. [9] (10.1007/s11678-018-0488-7)
• [L4] [10] (10.1007/s00068-021-01765-2)
• [L3] Both operative procedures effectively treat Mayo type II olecranon fractures. [11] (10.1186/s12891-025-08843-1)
• [L4] A majority of olecranon fractures heal uneventfully with good/excellent results with a small loss of motion to be expected. [12] (10.1016/j.hcl.2015.07.003)
• [L4] For these less than 5 per cent of all fractures of the olecranon, a bent plate is a practical and satisfactory alternative. [13] (10.1016/s0020-1383(73)80090-7)
• [L1] These data further support the role of primary non-operative management of isolated displaced fractures of the olecranon in the elderly. [14] (10.1302/0301-620x.99b7.bjj-2016-1112.r2)
• [L3] The incidence of olecranon fractures increased by 29% over the 20-year study period. [15] (10.1186/s13018-025-05970-2)
• [L4] Plate fixation is an effective treatment option for displaced olecranon fractures with a good functional outcome and a low incidence of complications. [16] (10.1097/00005131-200111000-00002)
• [L4] We found satisfactory short-term and long-term outcomes following the nonoperative management of isolated displaced olecranon fractures in older, lower-demand patients. [17] (10.2106/jbjs.l.01137)
• [L2] While they did not definitively settle the debate about whether we should manage olecranon fractures nonoperatively in patients over 75, they did offer valuable data that surgeons and patients can use to develop personalized treatment plans tailored to each patient's needs. [18] (10.2106/jbjs.24.01097)
• [L4] Suture anchor fixation of displaced olecranon fractures resulted in excellent midterm functional outcomes. [19] (10.5397/cise.2023.00528)
• [L3] The timing of fixation of displaced olecranon fractures does not significantly increase the rate of early complications or reoperation. [21] (10.1016/j.jhsg.2023.09.002)
• [L5] Fixation must be secure enough to permit early motion to avoid significant stiffness of the elbow joint. [22] (10.5435/00124635-200007000-00007)
• [Paper] No one technique is suitable for the management of all olecranon fractures. [23] (10.1016/j.injury.2008.12.013)
• [L3] Patients with olecranon fractures have essentially similar demographic characteristics compared to patients with distal radius fractures. [24] (10.1177/17585732221124301)
• [L3] Plating of the olecranon leads to predictable union, though the most common complication was lack of full extension in 39% of patients. [25] (10.1016/j.injury.2016.04.015)
• [L4] Olecranon fractures in children are usually undisplaced and incomplete, with the 'longitudinal split' fracture being not uncommon. [26] (10.1016/0020-1383(75)90056-x)
• [L2] This document is a study protocol and does not report results or conclusions; the study aims to test for superiority of operative treatment versus non-operative treatment for displaced olecranon fractures in the elderly by comparing pain and function up to one year after injury. [27] (10.1186/s12891-015-0789-6)
• [L3] Olecranon fractures in the elderly have higher than expected 1 year mortality rates. [30] (10.1177/1758573221994860)
• [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. [31] (10.1016/0020-1383(80)90009-1)
• [L4] [33] (10.1016/j.jse.2026.02.024)
• [L4] Non-operative treatment of Mayo Type II olecranon fractures may be successful, extending the age range for which such treatment of displaced olecranon fractures can be considered. [34] (10.1177/1758573217711889)
• [L4] Articular impaction is a common feature of geriatric olecranon fractures. [38] (10.5435/jaaos-d-20-01293)
• [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. [40] (10.1177/147323001204000324)
• [L4] Patients who present with a non-union after a displaced olecranon fracture managed non-operatively have reasonable elbow function and uncommonly request operative treatment. [41] (10.1111/j.1758-5740.2012.00194.x)
• [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. [42] (10.1177/1558944720944261)
• [L3] Fractures of the ipsilateral olecranon associated with the radial neck are not so rare as previously reported. [43] (10.1186/s13018-021-02373-x)
• [L4] [44] (10.1016/j.jhsa.2012.12.036)
• [L4] [46] (10.1016/0020-1383(87)90386-x)
• [L5] The Mayo classification was designed to simplify categorization of olecranon fractures but does not achieve this goal due to poor reproducibility. [48] (10.1097/corr.0000000000000614)
• [L1] Plate has better efficacy and safety for Mayo II olecranon fractures. [51] (10.1186/s13018-022-03262-7)
• [L4] In cases with concomitant injuries, the risk of limited elbow motion is high. [57] (10.1016/j.jse.2010.11.023)
• [L1] [59] (10.2106/jbjs.24.00655)
• [L4] DTBW produced good clinical and radiological outcomes and could be an effective option for the treatment of olecranon fractures by providing additional stability through a second TBW. [60] (10.1016/j.jhsa.2014.09.020)
• [L4] TBW remains an effective treatment for appropriately selected olecranon fractures and in this cohort outperformed plate osteosynthesis. [61] (10.1007/s00590-015-1724-0)
• [L3] Both implant types could be appropriate surgical techniques for fixation of selected olecranon fractures and osteotomies. [62] (10.1007/s00264-013-1854-0)
• [L5] Current elbow fracture dislocation classification systems only describe one element of the injury or only include one pattern. [64] (10.1177/1758573219884010)
• [L4] Plate fixation of complex olecranon fracture is an effective, reliable method of treatment with low risk of non-union. [66] (10.1016/j.ijscr.2017.10.052)
• [L5] The clinical role of locked IMN fixation for the treatment of olecranon fractures and olecranon osteotomies needs to be defined, however, by controlled, randomized prospective trials. [68] (10.1097/00005131-200403000-00008)
• [L4] Olecranon fractures are commonly seen in orthopedic practice and have good to excellent outcomes with adherence to a treatment algorithm based on displacement, comminution, and joint stability. [69] (10.1016/j.ocl.2008.01.002)
• [L4] Suture fixation is now the mainstay of treatment for all simple olecranon fractures, with no re-operations or wound complications observed in this series. [71] (10.1177/1758573216687305)
• [L4] We recommend this technique to be used in displaced transverse or oblique fractures of the olecranon in children. [72] (10.1097/bte.0b013e318254642f)
• [L2] The study showed that OMC could be an effective alternative to treat olecranon fractures. [86] (10.1007/s00264-013-1878-5)
• [Letter] The authors of the original review acknowledge that nonsurgical management was limited to nondisplaced fractures due to editorial constraints but maintain that surgical management remains the standard of care for displaced olecranon fractures until more convincing evidence supports nonsurgical treatment. [88] (10.1016/j.jhsa.2013.04.013)
• [Paper] A flexion-extension 'arc of injury' was shown which relates fracture types to elbow position at the moment of impact. [89] (10.1016/0020-1383(95)93494-3)
• [L4] Concurrent ipsilateral carpal and elbow injuries are rare and represent a severe injury to the upper limb caused by a longitudinal force vector of considerable magnitude. [93] (10.1016/s0266-7681(05)80123-8)
• [Abstract] Good functional long-term results are to be expected in patients with complex olecranon fractures treated with open reduction and internal fixation, despite arthritic changes in the elbow joint. [94] (10.1016/j.jse.2007.02.092)
• [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. [98] (10.1016/j.injury.2025.112579)
• [L4] This method provides a quick, safe and effective method of fixing olecranon fractures and appears to give a high level of patient satisfaction. [106] (10.1016/s0020-1383(97)00056-9)
• [L4] Non-operative functional treatment of displaced olecranon fractures in the elderly provides a satisfactory and functional range of motion with a high rate of satisfaction. [110] (10.1302/0301-620x.96b4.33339)
• [L4] Quantitative analysis of olecranon fractures further clarified fracture morphology of Mayo type I, II, and III fractures. [113] (10.1016/j.jse.2015.10.002)
• [L3] Low-profile double-plate osteosynthesis for treating olecranon fractures resulted in good clinical outcomes. [114] (10.1016/j.jse.2020.01.091)
• [L4] Displaced olecranon fractures in elderly and medically unwell patients treated nonoperatively can result in reasonable range of motion, minimal pain, and maintenance of extension against gravity. [115] (10.1016/j.jseint.2020.11.001)
• [L4] [123] (10.1016/j.jor.2019.09.017)
• [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. [128] (10.1016/j.xrrt.2025.08.004)
• [L4] [129] (10.1016/j.jse.2023.12.021)
• [L3] [132] (10.1016/j.injury.2011.10.017)
• [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. [136] (10.2106/00004623-198163050-00005)
• [L4] [145] (10.1016/j.injury.2024.111496)
• [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. [146] (10.1007/s11999-015-4488-2)
• [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. [154] (10.2106/jbjs.16.00773)
• [L5] Detailed radiological assessment of the fractures pattern is vital to understand the mechanism of injury, allowing clinicians to predict the associated capsuloligamentous injury and help guide the management decisions. [156] (10.1007/s10140-021-01978-3)

See Also

• Radial Head Fracture

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