Olecranon Fracture Info
Last reviewed
Olecranon fractures — patterns, non-operative care, and tension-band or plate fixation.
What you're feeling
You will feel sharp pain right at the back of your elbow, where the bone is most prominent. This is the spot where the triceps muscle attaches to your arm. The pain often flares up when you try to straighten your arm against any resistance. It can also hurt when you wake up in the morning or after a long day of activity. Many patients find that sleeping on the side of the injury is very difficult and keeps them awake.
Daily tasks become harder because moving your elbow feels unstable or weak. You might struggle to reach behind your back to fasten a bra or tuck in a shirt. Simple actions like lifting a cup of coffee or pushing up from a chair can trigger a sharp ache. If you are older, your surgeon may note that articular impaction is common in your injury. This means the joint surfaces are pressing against each other, which adds to the discomfort.
Over time, you might notice that the pain does not go away completely. About 19% of patients develop wear-and-tear arthritis within 41 months after the injury. This can cause stiffness or aching that comes and goes. While some treatments focus on fixing the bone, others aim to manage the pain without surgery. Your surgeon will discuss which path is best for your specific situation and goals.
What's actually happening
Your elbow works like a hinge where the end of your upper arm bone meets the top of your forearm bone. The olecranon is the bony tip of your forearm that forms the back of this hinge. When you break this bone, you often tear the triceps tendon, which is the strong rope of fibers that lets you straighten your arm. If this connection breaks, you may lose the ability to lift your arm overhead or push things away.
Your surgeon aims to fix this break so the joint surface is smooth again. A smooth surface is vital because it prevents the bones from grinding against each other. If the joint is not aligned perfectly, wear-and-tear arthritis can develop later. About 19% of patients develop this arthritis after about 41 months. This can cause pain and stiffness, limiting how well you can move your elbow over time.
Sometimes, the break is complex because other parts of the elbow are also injured. These added injuries increase the risk that your elbow will not move as freely as it should. In older patients, the surgeon may decide that surgery is not needed if the fracture is isolated. Non-operative care can still lead to good function and high satisfaction in this group. The main goal is always to restore your ability to use your arm while avoiding unnecessary complications from surgery.
What we can do about it
For many patients, especially older adults, you may not need surgery right away. Your surgeon might recommend a period of rest and gentle movement to let the bone heal on its own. This approach works well for isolated fractures in the elderly or those with lower activity levels. You can expect to keep your elbow moving early to avoid stiffness, which is a common risk after this injury. Many patients achieve a satisfactory range of motion and high satisfaction without an operation, even if the fracture was displaced.
If you are in pain, your surgeon will guide you on using pain medication and anti-inflammatories to manage discomfort. While the evidence does not specify injections like cortisone or PRP for this specific injury, the goal of medical management is to keep you comfortable while the bone stabilizes. For some patients, particularly those over 70, non-operative care results in minimal pain and the ability to lift your arm against gravity. If you have a non-union after trying non-surgical care, you may still have reasonable elbow function and rarely need to ask for surgery later.
Surgery is usually considered when the bone is displaced and needs to be held in place to heal correctly. Your surgeon may use plates, wires, or anchors to fix the bone, ensuring it is secure enough for you to move your elbow early. In some cases, removing the broken piece of bone and repairing the muscle is the preferred method to reduce complications. Most patients who have surgery keep their implants in place, and only 3% experience any movement of the hardware. If you are over 75, your surgeon will discuss whether the risks of surgery outweigh the benefits based on your personal health.
When to see someone
See your GP if you have persistent pain that does not improve with rest. Ask for a specialist review if you feel weakness or instability in your elbow. Contact your surgeon if your joint locks or gives way. Seek help if symptoms interfere with sleep or work. Sudden worsening of pain also requires attention. While most patients keep their implants, 3% experience implant migration after surgery. Be aware that 19% of patients develop wear-and-tear arthritis within 41 months. Elderly patients face higher mortality rates within one year. If you are over 65, discuss these risks with your care team.
