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Trauma & Fractures

Olecranon Fracture

Fracture of the Elbow Tip

Tension band wiring, plate fixation, and rehabilitation for optimal outcomes

Understanding Olecranon Fractures

The olecranon is the prominent bony tip of the elbow that you feel when bending your arm. It forms part of the ulna and is where the triceps tendon inserts. This makes it essential for elbow extension (straightening).

Key Facts

  • • 10% of all upper extremity fractures
  • • Bimodal distribution: young (high energy) and elderly (falls)
  • • Most require surgical fixation
  • • Superficial location means hardware often symptomatic
  • • Early motion critical to prevent stiffness

Mayo Classification

Type I
Non-displaced

Displacement <2mm, ulnohumeral joint stable

IA: Non-comminuted

IB: Comminuted

Treatment: May be non-operative if stable

Type II
Displaced, Stable

Displacement >2mm, ulnohumeral joint stable

IIA: Non-comminuted

IIB: Comminuted

Treatment: ORIF - TBW or plate

Type III
Unstable

Ulnohumeral joint unstable (subluxation/dislocation)

IIIA: Non-comminuted

IIIB: Comminuted

Treatment: ORIF + address instability

Treatment Options

Non-Operative (Select Type I)

Only for truly non-displaced fractures with intact extensor mechanism:

  • • Patient can actively extend elbow against gravity
  • • Splint at 45-90° flexion for 3 weeks
  • • Serial X-rays to monitor for displacement
  • • Protected ROM starts early
Tension Band Wiring (TBW)

Classic technique for simple transverse fractures:

  • • Two parallel K-wires through olecranon into anterior ulna
  • • Figure-of-8 wire around K-wire ends and through ulna
  • • Converts tension (triceps pull) to compression at fracture
  • • Allows early motion

Pros: Simple, inexpensive, proven technique
Cons: 80% symptomatic hardware requiring removal, not for comminuted fractures

Plate Fixation

Preferred for comminuted, oblique, or complex fractures:

  • • Posterior plate along subcutaneous border
  • • Precontoured locking plates available
  • • Better for comminuted fractures (Mayo IIB, IIIB)
  • • Low-profile designs reduce hardware symptoms

Pros: Stable for comminuted fractures, lower symptomatic hardware rate
Cons: More extensive surgery, higher cost

Intramedullary Screw

Alternative for simple transverse fractures:

  • • Long intramedullary screw with washer
  • • Less prominent hardware
  • • Lower revision rate than TBW

Complications & Outcomes

Common Complications

Symptomatic hardware (most common)
Loss of extension (typically 10-15°)
Heterotopic ossification
Nonunion (rare with fixation)
Post-traumatic arthritis
Ulnar nerve irritation

Expected Outcomes

85-90% good to excellent results
Average flexion arc: 10-130°
Full strength return at 4-6 months
Return to work: 6-12 weeks (desk)
Return to manual labor: 3-4 months
Hardware removal: 20-80% (varies by technique)

Evidence & References

• Morrey BF. Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid. JBJS Am 1995

• Hume MC, Wiss DA. Olecranon fractures: A clinical and radiographic comparison of tension band wiring and plate fixation. Clin Orthop 1992

• Duckworth AD, et al. The epidemiology of fractures of the proximal ulna. Injury 2012

• Schneider MM, et al. Tension band wiring versus plate fixation for olecranon fractures. J Orthop Trauma 2014

Last Updated: January 2025 | Content reviewed by Dr. Deepthi Nandan Reddy, FRCS (Ortho)

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