Diagnostic Considerations

The differential diagnosis of olecranon fracture includes olecranon bursitis, fractures of the supracondylar humerus, triceps tendon rupture, and elbow dislocation. Radiography, magnetic resonance imaging (MRI), and computed tomography (CT) scans can usually provide the diagnosis if necessary.

Workup

Rouleau DM, Sandman E, van Riet R, Galatz LM. Management of fractures of the proximal ulna. J Am Acad Orthop Surg. 2013 Mar. 21 (3):149-60. [QxMD MEDLINE Link].
Newman SD, Mauffrey C, Krikler S. Olecranon fractures. Injury. 2009 Jun. 40 (6):575-81. [QxMD MEDLINE Link].
Veillette CJ, Steinmann SP. Olecranon fractures. Orthop Clin North Am. 2008 Apr. 39 (2):229-36, vii. [QxMD MEDLINE Link].
Anderson ML, Larson AN, Merten SM, Steinmann SP. Congruent elbow plate fixation of olecranon fractures. J Orthop Trauma. 2007 Jul. 21 (6):386-93. [QxMD MEDLINE Link].
Phadnis JS, Vaughan A, Luokkala T, Peters J, Watson JJ, Watts A. Comparison of all suture fixation with tension band wiring and plate fixation of the olecranon. Shoulder Elbow. 2020 Dec. 12 (6):414-421. [QxMD MEDLINE Link].
Greif DN, Emerson CP, Allegra P, Shallop BJ, Kaplan LD. Olecranon Stress Fracture. Clin Sports Med. 2020 Jul. 39 (3):575-588. [QxMD MEDLINE Link].
Flinterman HJ, Doornberg JN, Guitton TG, Ring D, Goslings JC, Kloen P. Long-term outcome of displaced, transverse, noncomminuted olecranon fractures. Clin Orthop Relat Res. 2014 Jun. 472 (6):1955-61. [QxMD MEDLINE Link]. [Full Text].
Erturer RE, Sever C, Sonmez MM, Ozcelik IB, Akman S, Ozturk I. Results of open reduction and plate osteosynthesis in comminuted fracture of the olecranon. J Shoulder Elbow Surg. 2011 Apr. 20 (3):449-54. [QxMD MEDLINE Link].
Buijze GA, Blankevoort L, Tuijthof GJ, Sierevelt IN, Kloen P. Biomechanical evaluation of fixation of comminuted olecranon fractures: one-third tubular versus locking compression plating. Arch Orthop Trauma Surg. 2010 Apr. 130 (4):459-64. [QxMD MEDLINE Link]. [Full Text].
Buijze G, Kloen P. Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures. J Bone Joint Surg Am. 2009 Oct. 91 (10):2416-20. [QxMD MEDLINE Link].
Iannuzzi N, Dahners L. Excision and advancement in the treatment of comminuted olecranon fractures. J Orthop Trauma. 2009 Mar. 23 (3):226-8. [QxMD MEDLINE Link].
Mueller ME, Allgower M, Schneider R. Manual of Internal Fixation: Techniques Recommended by the AO-ASIF Group. 3rd ed. Berlin: Springer-Verlag; 1991.
Schatzker J, Tile M. Fractures of the olecranon. The Rationale of Operative Fracture Care. 3rd ed. Berlin: Springer-Verlag; 2005. 123-30.
Morrey BF. Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid. Instr Course Lect. 1995. 44:175-85. [QxMD MEDLINE Link].
Benetton CA, Cesa G, El-Kouba Junior G, Ferreira AP, Vissoci JR, Pietrobon R. Agreement of olecranon fractures before and after the exposure to four classification systems. J Shoulder Elbow Surg. 2015 Mar. 24 (3):358-63. [QxMD MEDLINE Link].
Wenger D, Cornefjord G, Rogmark C. Cerclage fixation without K-wires is associated with fewer complications and reoperations compared with tension band wiring in stable displaced olecranon fractures in elderly patients. Arch Orthop Trauma Surg. 2021 Jul 8. [QxMD MEDLINE Link].
McKEEVER FM, BUCK RM. Fracture of the olecranon process of the ulna; treatment by excision of fragment and repair of triceps tendon. J Am Med Assoc. 1947 Sep 6. 135 (1):1-5. [QxMD MEDLINE Link].
Gallucci GL, Piuzzi NS, Slullitel PA, Boretto JG, Alfie VA, Donndorff A, et al. Non-surgical functional treatment for displaced olecranon fractures in the elderly. Bone Joint J. 2014 Apr. 96-B (4):530-4. [QxMD MEDLINE Link].
Duckworth AD, Bugler KE, Clement ND, Court-Brown CM, McQueen MM. Nonoperative management of displaced olecranon fractures in low-demand elderly patients. J Bone Joint Surg Am. 2014 Jan 1. 96 (1):67-72. [QxMD MEDLINE Link].
Gartsman GM, Sculco TP, Otis JC. Operative treatment of olecranon fractures. Excision or open reduction with internal fixation. J Bone Joint Surg Am. 1981 Jun. 63 (5):718-21. [QxMD MEDLINE Link].
Murphy DF, Greene WB, Dameron TB Jr. Displaced olecranon fractures in adults. Clinical evaluation. Clin Orthop Relat Res. 1987 Nov. (224):215-23. [QxMD MEDLINE Link].
Rush LV, Rush HL. A reconstruction operation for a comminuted fracture of the upper third of the ulna. Am J Surg. 1937. 38:332-3.
Sultan S, Khan AZ. Management of comminuted fractures of the olecranon by tension band wiring. J Ayub Med Coll Abbottabad. 2003 Jul-Sep. 15 (3):27-9. [QxMD MEDLINE Link].
Midtgaard KS, Frihagen F, Dornan GJ, Coucheron M, Fossåen C, Grundel D, et al. Predicting secondary surgery after operative fixation of olecranon fractures: a model using data from 800 patients. JSES Int. 2021 Sep. 5 (5):948-953. [QxMD MEDLINE Link].
Gross JM. Core curriculum lectures: upper extremity. 8: Olecranon fractures – a case based approach to understanding management. Orthopaedic Trauma Association. Available at https://ota.org/sites/files/2021-06/UE%208%20Olecranon%20Fractures.pdf. June 13, 2021; Accessed: December 8, 2021.
Matar HE, Ali AA, Buckley S, Garlick NI, Atkinson HD. Surgical interventions for treating fractures of the olecranon in adults. Cochrane Database Syst Rev. 2014 Nov 26. 11:CD010144. [QxMD MEDLINE Link].
Inhofe PD, Howard TC. The treatment of olecranon fractures by excision or fragments and repair of the extensor mechanism: historical review and report of 12 fractures. Orthopedics. 1993 Dec. 16 (12):1313-7. [QxMD MEDLINE Link].
Moed BR, Ede DE, Brown TD. Fractures of the olecranon: an in vitro study of elbow joint stresses after tension-band wire fixation versus proximal fracture fragment excision. J Trauma. 2002 Dec. 53 (6):1088-93. [QxMD MEDLINE Link].
Wolfgang G, Burke F, Bush D, Parenti J, Perry J, LaFollette B, et al. Surgical treatment of displaced olecranon fractures by tension band wiring technique. Clin Orthop Relat Res. 1987 Nov. (224):192-204. [QxMD MEDLINE Link].
Raju SM, Gaddagi RA. Cancellous screw with tension band wiring for fractures of the olecranon. J Clin Diagn Res. 2013 Feb. 7 (2):339-41. [QxMD MEDLINE Link]. [Full Text].
Jones TB, Karenz AR, Weinhold PS, Dahners LE. Transcortical screw fixation of the olecranon shows equivalent strength and improved stability compared with tension band fixation. J Orthop Trauma. 2014 Mar. 28 (3):137-42. [QxMD MEDLINE Link].
Takada N, Kato K, Fukuta M, Wada I, Otsuka T. Minimally invasive tension band wiring technique for olecranon fractures. Tech Hand Up Extrem Surg. 2013 Dec. 17 (4):199-201. [QxMD MEDLINE Link].
Wang K, Lu Y, Shen Y, Cai W, Zhan S, Ding J. Where should the pins be placed to decrease the failure rate after fixation of a Mayo IIA olecranon fracture? A biomechanical analysis. Injury. 2020 Jul. 51 (7):1522-1526. [QxMD MEDLINE Link].
Saeed ZM, Trickett RW, Yewlett AD, Matthews TJ. Factors influencing K-wire migration in tension-band wiring of olecranon fractures. J Shoulder Elbow Surg. 2014 Aug. 23 (8):1181-6. [QxMD MEDLINE Link].
Kim JY, Lee YH, Gong HS, Lee SL, Lee SK, Baek GH. Use of Kirschner wires with eyelets for tension band wiring of olecranon fractures. J Hand Surg Am. 2013 Sep. 38 (9):1762-7. [QxMD MEDLINE Link].
Schneider MM, Nowak TE, Bastian L, Katthagen JC, Isenberg J, Rommens PM, et al. Tension band wiring in olecranon fractures: the myth of technical simplicity and osteosynthetical perfection. Int Orthop. 2014 Apr. 38 (4):847-55. [QxMD MEDLINE Link]. [Full Text].
Simpson NS, Goodman LA, Jupiter JB. Contoured LCDC plating of the proximal ulna. Injury. 1996 Jul. 27 (6):411-7. [QxMD MEDLINE Link].
King GJ, Lammens PN, Milne AD, Roth JH, Johnson JA. Plate fixation of comminuted olecranon fractures: an in vitro biomechanical study. J Shoulder Elbow Surg. 1996 Nov-Dec. 5 (6):437-41. [QxMD MEDLINE Link].
Cho JW, Oh JK, Um J, Sohn HS. Outcomes of embedded rafting k-wire technique for intermediate articular fragment fixation in comminuted olecranon fractures. Arch Orthop Trauma Surg. 2021 Sep 23. [QxMD MEDLINE Link].
Hak DJ, Golladay GJ. Olecranon fractures: treatment options. J Am Acad Orthop Surg. 2000 Jul-Aug. 8 (4):266-75. [QxMD MEDLINE Link].
Paci JM, Dugas JR, Guy JA, Cain EL Jr, Fleisig GS, Hurst C, et al. Cannulated screw fixation of refractory olecranon stress fractures with and without associated injuries allows a return to baseball. Am J Sports Med. 2013 Feb. 41 (2):306-12. [QxMD MEDLINE Link].
Olecranon Osteotomy Nail. Synthes, Inc. Available at http://synthes.vo.llnwd.net/o16/LLNWMB8/US%20Mobile/Synthes%20North%20America/Product%20Support%20Materials/Technique%20Guides/SUTGOlecranonJ8376C.pdf. 2009; Accessed: December 8, 2021.
Nowak TE, Burkhart KJ, Andres T, Dietz SO, Klitscher D, Mueller LP, et al. Locking-plate osteosynthesis versus intramedullary nailing for fixation of olecranon fractures: a biomechanical study. Int Orthop. 2013 May. 37 (5):899-903. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

Lateral radiograph of elbow in 78-year-old man who fell on his outstretched hand. Displaced fracture of olecranon was noted.
Drawing depicting radial bow of proximal third of ulna.
Anteroposterior radiograph following reduction and internal fixation of fracture with 7.3-mm cannulated screw and 1.6-mm cable.
Lateral radiograph demonstrating threads of screw engaging cortices of ulna.
Typical relatively transverse olecranon fracture.
Pediatric olecranon fracture.
Olecranon process consists of bone of proximal ulna from base of coronoid process (down arrow) proximally. Trochlear notch (up arrows; also called semilunar notch) is articular surface shown between two arrows.
Incorrect tension band technique: pins should be anchored in anterior cortex and not placed down medullary canal.
Transverse olecranon fracture without comminution.
Transverse olecranon fracture treated with tension band technique (ideally, both K-wires should have been anchored in anterior cortex).
Lateral plate position for olecranon fracture fixation.
Posterior plate position for olecranon fracture.
Example of distal olecranon fracture.
Plate fixation of distal olecranon fracture.
Comminuted olecranon fracture.
Plate fixation of comminuted olecranon fracture.
Example of specialized olecranon plate.
20-year-old man with comminuted olecranon fracture extending distally into ulnar shaft from gunshot injury.
Bridge plating of comminuted olecranon fracture extending into proximal ulna diaphysis after gunshot injury.
Monteggia-variant fracture-dislocation: olecranon and radial head fractures.
Monteggia-variant fracture-dislocation treated with fixation of both fractures.
Monteggia-variant fracture of proximal ulna and radial head.
Monteggia-variant fracture-dislocation treated with plate fixation of olecranon and proximal ulna and replacement of radial head.
Example of intramedullary screw fixation of olecranon fracture. In this case, screw diameter was too small and loss of fixation has occurred.
Intramedullary rod fixation of olecranon osteotomy used in repair of distal humerus fracture.
79-year-old man with olecranon fracture.
AP radiograph of tension band wiring of olecranon fracture in 79-year-old man.
Lateral radiograph of tension band wiring in 79-year-old man with olecranon fracture. Note excellent technique with anatomic reduction, K-wires anchored in anterior cortex, and tension band wire placed dorsally.
Nonunion of olecranon fracture in 79-year-old man despite excellent tension band wiring technique.
Excision of olecranon after nonunion of fracture in 79-year-old man.
Comminuted olecranon fracture.
Comminuted olecranon fracture plated with proximal edge off bone to allow two more screws in proximal segment and fixed angled intramedullary screw (bending plate distorts locking hole).
Healed comminuted olecranon fracture after removal of prominent plate fixation.
Olecranon nonunion after nonoperative treatment.
Repair of olecranon nonunion with double-plate technique (original fracture was treated nonoperatively).
AP radiograph of healed olecranon nonunion after original nonoperative treatment; repaired with double-plate technique.
Lateral radiograph of healed olecranon nonunion after original nonoperative treatment; repaired with double-plate technique.
MRI showing olecranon stress fracture.
Use of pins to raft joint surface of comminuted olecranon fracture with plate fixation of fracture as well.

of 39

Author

Steven I Rabin, MD, FAAOS Clinical Associate Professor, Department of Orthopedic Surgery and Rehabilitation, Loyola University, Chicago Stritch School of Medicine; Medical Director, Musculoskeletal Services, Dreyer Medical Clinic

Steven I Rabin, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Fracture Association, American Orthopaedic Association, AO Foundation, Chicago Metropolitan Trauma Society, Illinois Association of Orthopaedic Surgeons, Limb Lengthening and Reconstruction Society, Mid-America Orthopaedic Association, Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Thomas M DeBerardino, MD, FAAOS, FAOA Professor of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, Joe R and Teresa Lozano Long School of Medicine; Professor of Orthopaedic Surgery and Faculty of Sports Medicine Fellowship, Baylor College of Medicine; Sports Medicine Orthopaedic Surgeon, Department of Orthopaedics, UT Health San Antonio; Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder

Thomas M DeBerardino, MD, FAAOS, FAOA is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Clinical Orthopaedic Society, Herodicus Society, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Arthrex, Inc.; MTF; Aesculap; Conmed; JRF<br/>Received research grant from: Arthrex, Inc.; MTF.

Additional Contributors

Mark D Lazarus, MD Associate Professor of Orthopedic Surgery, Medical College of Pennsylvania-Hahnemann University, Chief of Shoulder and Elbow Service, Department of Orthopedic Surgery, Hahnemann University Hospital

Disclosure: Nothing to disclose.

Acknowledgements

SPECIAL THANKS TO THE ORIGINAL AUTHORS OF THIS ARTICLE. MUCH OF THEIR MATERIAL HAS BEEN RETAINED IN THIS VERSION.

Margaret A Porembski, MD Attending Physician, Oklahoma Hand Fellowship

Margaret A Porembski, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, and American Society for Surgery of the Hand

Disclosure: Nothing to disclose.

James W Pritchett, MD Chief of Orthopedic Surgery, Swedish Orthopedic Institute; Active Staff, Swedish Medical Center

James W Pritchett, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, Association of Bone and Joint Surgeons, and Washington State Medical Association

Disclosure: Nothing to disclose.