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Education · elbow

Olecranon Fracture Info Evidence

Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed

What you're feeling

You will likely feel sharp pain at the very tip of your elbow. This is where the olecranon bone sits. The pain often worsens when you try to straighten your arm against resistance. You might also feel a deep ache that flares up after you have been using your arm for daily tasks.

Simple movements can become difficult. Reaching behind your back to fasten a bra may hurt. Tucking in a shirt or lifting a light object can trigger a spike in discomfort. You may find it hard to rest your arm on a table because the pressure on the bony tip is painful.

Sleeping can be challenging. Many patients find they cannot lie on the affected side. The weight of your body presses directly on the injured elbow, causing significant pain. You might wake up with a stiff, aching elbow that feels tight in the morning.

Some swelling and bruising are common in the days following the injury. The area may feel warm to the touch. If you have an older fracture, you might notice that the pain changes with the weather or after long periods of inactivity.

It is important to listen to your body. Resting the arm in a comfortable position, often slightly bent, can help reduce the strain on the triceps muscle. Avoiding heavy lifting or pushing motions can prevent further irritation of the joint.

While these symptoms are typical, they can vary from person to person. Some people experience more stiffness than pain, while others feel sharp, localized tenderness. If your pain becomes severe or you notice increased swelling, contact your surgeon. They can help determine if your symptoms align with a simple fracture or if there are other factors at play, such as wear-and-tear arthritis developing in the joint over time.

What's actually happening

Your elbow is a hinge joint where your upper arm bone meets your forearm bone. The olecranon is the bony tip of your elbow that you feel when you bend your arm. It acts like a hook, catching on your upper arm bone to keep the joint stable. A fracture here means this critical anchor point has broken.

When the bone breaks, the strong triceps tendon attached to it can pull the fragment away. This disrupts the smooth surface of the joint. Without a smooth surface, your elbow cannot glide properly. You may lose the ability to straighten your arm fully against gravity. This happens because the mechanical lever system is no longer aligned.

The joint is also surrounded by a protective sleeve called the joint capsule. If the break is displaced, this sleeve can tear or stretch. This leads to swelling and pain. In some cases, the break is complex, involving multiple pieces or instability in the surrounding ligaments. This makes the joint feel loose or unstable.

Your surgeon aims to restore the smooth, congruent surface of the joint. This allows your arm to function normally again. For older patients with lower physical demands, non-operative management may be sufficient. The body can sometimes heal the break enough to provide satisfactory function, even if the bone does not fuse perfectly. However, for many, secure fixation is needed to allow early motion. This prevents the joint from becoming stiff.

If surgery is required, the goal is to hold the pieces in place so they heal. Techniques vary from wires and screws to sutures or removing the broken tip entirely. The choice depends on the fracture pattern and your overall health. While most patients regain good function, there is a risk of long-term wear-and-tear arthritis. The median incidence of post-traumatic osteoarthritis following isolated olecranon fractures is 19% at a median follow-up of 41 months. This means the joint may ache or stiffen over time, but many people remain active and satisfied with their recovery.

What we can do about it

How Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, approaches this in our clinic reflects a shared decision based on your specific injury and health profile. Patients reach our clinic by GP or physiotherapist referral. A clinic assessment establishes the diagnosis. For acute fractures, we often recommend surgery straight away. For other cases, we usually try non-operative care first.

You can manage mild symptoms with rest and ice. Physiotherapy aims to restore movement and strength without causing pain. We typically suggest giving this approach a few weeks to show results. If you are older or have other health conditions, non-operative management may be the best choice. Evidence shows that many elderly patients achieve a satisfactory range of motion and high satisfaction without surgery. Even if the bone does not fully heal, many patients report reasonable elbow function and minimal pain.

Your surgeon will prescribe pain medication to help you cope. Anti-inflammatories reduce swelling. Injections are not routinely used for acute fractures but may be considered for long-term wear-and-tear arthritis. Cortisone injections reduce inflammation for a few weeks. Hyaluronic acid injections lubricate the joint for several months. Platelet-rich plasma injections aim to support healing, though effects vary. We discuss these options only if they fit your long-term goals.

Surgery is considered when conservative care does not provide enough improvement or when the fracture is displaced. The operation repairs the broken bone or removes the small fragment to restore the triceps muscle function. This allows you to move your elbow again. Most patients keep their implants, with only 3% experiencing implant migration. We guide you through this decision, ensuring you understand the benefits and risks for your unique situation.

What to expect

Your outlook depends largely on your age and daily activity levels. For older adults with lower physical demands, non-surgical management often provides satisfactory short-term and long-term outcomes. Many patients in this group achieve high satisfaction and a functional range of motion without surgery. Even if a fracture does not heal perfectly (non-union), elbow function often remains reasonable, and most do not request further operation.

If you are younger or more active, surgical fixation is typically recommended to restore strength. Most patients retain their implants after this procedure, with only 3% experiencing implant migration. The timing of surgery does not significantly increase early complications or the need for reoperation. Whether treated with wires, plates, or anchors, functional outcomes are generally good. Among active patients, there is no difference in patient-reported outcomes at 1 year between common surgical methods like tension-band wire and plate fixation.

You should be aware of potential long-term changes. The median incidence of post-traumatic osteoarthritis following isolated olecranon fractures is 19% at a median follow-up of 41 months. This wear-and-tear arthritis can cause stiffness or pain over time. However, good functional long-term results are still expected in complex cases, even if arthritic changes are present.

For elderly patients, the injury carries higher than expected 1-year mortality rates compared to other fractures. This reflects the overall health status of this demographic rather than the fracture itself. If you are over 75, evidence does not definitively settle the debate on nonoperative management, but it offers data for personalized treatment plans. Your surgeon will discuss which path aligns best with your specific health profile and goals.

When to see someone

See your GP if you have persistent pain that does not improve with rest, or if your elbow feels weak or unstable. Ask for a specialist review if your joint locks, gives way, or if symptoms interfere with your sleep or work. Sudden worsening of pain is also a reason to seek care. While most fractures heal well, be aware that 19% of patients may develop wear-and-tear arthritis later. In older adults, these injuries carry a higher risk of serious health complications within the first year. Early assessment helps manage these risks and ensures you get the right support for your recovery.

Reviewed by AI synthesis (v2) — pending human review · 18 May 2026.

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Evidence & references

Overview

  • Non-operative treatment of olecranon fractures in patients aged ≥75 years provided excellent functional results at 6 months without associated complications [1].
  • Nonoperative management of isolated displaced olecranon fractures in older, lower-demand patients yields satisfactory short-term and long-term outcomes [4].
  • Evidence offers valuable data for developing personalized treatment plans for olecranon fractures in patients over 75, though it does not definitively settle the debate on operative versus non-operative management [5].
  • The SOFIE trial is a study protocol aiming to test for superiority of operative versus non-operative treatment for displaced olecranon fractures in the elderly by comparing pain and function up to one year after injury, but it does not report results or conclusions [18].
  • Low-profile double-plate osteosynthesis is a safe and effective alternative treatment for olecranon fractures with excellent subjective and objective clinical outcome measures [2].
  • Both Kirschner wire tension band combined with anatomical locking plate and other operative procedures effectively treat Mayo type II olecranon fractures [6].
  • Plating of the olecranon leads to predictable union, although the most common complication was lack of full extension in 39% of patients [8].
  • A majority of olecranon fractures heal uneventfully with good/excellent results, with a small loss of motion to be expected [9].
  • The timing of fixation for displaced olecranon fractures does not significantly increase the rate of early complications or reoperation [13].
  • Tension band wiring (TBW) remains an effective treatment for appropriately selected olecranon fractures and outperformed plate osteosynthesis in the studied cohort [25].
  • Suture fixation is the mainstay of treatment for all simple olecranon fractures, with no re-operations or wound complications observed in the series [28].
  • Surgical treatment of olecranon fractures is associated with a high rate of complications, and patients undergoing revisions beyond implant removal had poorer functional outcomes [58].
  • No significant differences in functional outcomes or secondary operations were found with respect to fracture type, gender, or surgical method in the context of surgical treatment complications [58].

Anatomy & Pathophysiology

  • Concomitant injuries in olecranon fractures are associated with a high risk of limited elbow motion [23].
  • Understanding relevant elbow anatomy and factors associated with stability allows for systematic treatment algorithms that ensure sufficient stability for early motion, leading to improved outcomes [29].
  • The modified rotational formula (MRCF) provides stable and accurate measurements of rotational displacement despite varying elbow rotations, addressing limitations of the previous method (PRCF) [30].
  • An anatomic model of terrible triad injury can be created by exerting axial compression on an elbow in 15° flexion and maximal pronation at speeds of 100 and 10 mm/min [33].
  • Individuals with elbow degenerative changes have no inferior subjective elbow function compared to those with normal radiographs, except in cases with joint space reduction [34].
  • Elbow range of motion and functional use are maintained in the midterm compared to short-term studies following hemiarthroplasty for distal humeral fractures [35].
  • The "spin move" is a maneuver that improves exposure of the coronoid process regardless of the degree of elbow instability [36].
  • Restoration of joint motion in posttraumatic stiff elbows is a difficult, time-consuming, and costly challenge [37].
  • A portion of the anterior lateral trochlear ridge (aLTR) is covered with articular cartilage but is non-articulating throughout the normal elbow range of motion [41].
  • Evaluation and management of elbow injuries in young athletes requires knowledge of immature developing anatomy, injury pathophysiology, and established treatment algorithms [44].
  • Reconstruction of the anterior capsule and ligamentous structures is important for providing stability to the elbow joint in complex fracture-dislocations [45].
  • Good elbow function can be restored in most cases of comminuted intra-articular distal humeral fractures with minor impairments that do not worsen quality of life [46].
  • Use of a standard surgical protocol for elbow dislocations with radial head and coronoid fractures restores sufficient stability to allow early postoperative motion, enhancing functional outcomes [47].
  • Disruptions in forearm structures may lead to forearm instability with consequences at the remaining structures [48].
  • Open fracture-dislocation (OFD) patterns have the worst functional outcomes among complex elbow injury patterns [51].
  • Proper treatment of coronoid fractures requires an understanding of the bony and soft tissue anatomy of the elbow and various injury mechanisms [52].
  • While range of motion is typically preserved after reoperation for intra-articular proximal ulna fractures, 35% of patients experience subsequent complications [53].
  • Orthogonal plate configuration, olecranon osteotomy, and longer operative time are associated with increased odds of dysfunctional elbow stiffness following operative fixation of distal humerus fractures [54].
  • Specific patterns of traumatic elbow instability have correspondingly specific coronoid fracture patterns [55].

Classification

  • The Mayo classification was designed to simplify categorization of olecranon fractures [31].
  • The Mayo classification does not achieve its goal of simplification due to poor reproducibility [31].
  • Quantitative 3-dimensional computed tomography analysis clarified the fracture morphology of Mayo type I, II, and III fractures [57].

Clinical Presentation

  • Olecranon fractures are commonly seen in orthopedic practice [56].
  • Isolated olecranon fractures occur after low-energy trauma, especially in older women (> 65 years) [16].
  • Articular impaction is a common feature of geriatric olecranon fractures [19].
  • Patients with olecranon fractures have essentially similar demographic characteristics compared to patients with distal radius fractures [7].
  • The incidence of olecranon fractures increased by 29% over the 20-year study period (1999–2018) in Denmark [3].
  • Olecranon fractures in the elderly have higher than expected 1 year mortality rates [14].
  • More precise studies are needed to properly quantify the specific incidence of various subtypes of forearm and olecranon fractures and associated risk factors [12].

Investigations

  • The incidence of olecranon fractures increased by 29% over a 20-year study period in Denmark [3].
  • More precise studies are needed to properly quantify the specific incidence of various subtypes of forearm and olecranon fractures and associated risk factors [12].
  • Isolated fractures of the olecranon occur after low-energy trauma, especially in older women (> 65 years) [16].
  • Patients with olecranon fractures have essentially similar demographic characteristics compared to patients with distal radius fractures [7].
  • Olecranon fractures in the elderly have higher than expected 1-year mortality rates [14].
  • Articular impaction is a common feature of geriatric olecranon fractures [19].

Treatment

Non-Operative Management

  • Non-operative treatment of olecranon fractures in patients aged ≥75 years provided excellent functional results at 6 months, without associated complications [1].
  • Nonoperative management of isolated displaced olecranon fractures in older, lower-demand patients yields satisfactory short-term and long-term outcomes [4].
  • Primary non-operative management is supported for isolated displaced fractures of the olecranon in the elderly [10].
  • 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 [21].
  • Patients who present with a non-union after a displaced olecranon fracture managed non-operatively have reasonable elbow function and uncommonly request operative treatment [27].
  • Nonoperative treatment as a reasonable option is supported for displaced stable olecranon fractures in elderly patients [40].
  • 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 [49].
  • Aggregate data support the non-operative treatment of isolated undisplaced olecranon fractures with good results [42].
  • The literature on the treatment of olecranon fractures in elderly patients is limited [15].
  • More precise studies are needed in order to properly quantify the specific incidence of various subtypes of forearm and olecranon fractures and associated risk factors [12].
  • While data offer valuable information for personalized treatment plans, it is not definitively settled whether olecranon fractures should be managed nonoperatively in patients over 75 [5].
  • The SOFIE study is a protocol testing for superiority of operative versus non-operative treatment and does not report results or conclusions [18].
  • Surgical management remains the standard of care for displaced olecranon fractures until more convincing evidence supports nonsurgical treatment [39].

Operative Management

  • Low-profile double-plate osteosynthesis is a safe and effective alternative treatment of olecranon fractures with excellent subjective and objective clinical outcome measures [2].
  • Both Kirschner wire tension band combined with anatomical locking plate and other operative procedures effectively treat Mayo type II olecranon fractures [6].
  • Suture anchor fixation of displaced olecranon fractures resulted in excellent midterm functional outcomes [11].
  • In cases with concomitant injuries, the risk of limited elbow motion is high following open reduction and plate osteosynthesis [23].
  • Double tension band wiring (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 tension band wire [24].
  • Tension band wiring (TBW) remains an effective treatment for appropriately selected olecranon fractures and outperformed plate osteosynthesis in the studied cohort [25].
  • Both locking-plate osteosynthesis and intramedullary nailing could be appropriate surgical techniques for fixation of selected olecranon fractures and osteotomies [26].
  • Plate has better efficacy and safety than tension band wire for Mayo II olecranon fractures [32].
  • The Nickel-Titanium olecranon memory connector (OMC) could be an effective alternative to treat olecranon fractures [38].
  • Plate fixation of complex olecranon fractures is an effective, reliable method of treatment with low risk of non-union [50].
  • No one technique is suitable for the management of all olecranon fractures [17].

Complications

  • Non-operative treatment of olecranon fracture in patients aged ≥75 years provided excellent functional results at 6 months without associated complications [1].
  • Low-profile double-plate osteosynthesis is a safe and effective alternative treatment of olecranon fractures with excellent subjective and objective clinical outcome measures [2].
  • Nonoperative management of isolated displaced olecranon fractures in older, lower-demand patients yields satisfactory short-term and long-term outcomes [4].
  • Plating of the olecranon leads to predictable union, though the most common complication was lack of full extension in 39% of patients [8].
  • A majority of olecranon fractures heal uneventfully with good/excellent results, with a small loss of motion to be expected [9].
  • Suture anchor fixation of displaced olecranon fractures resulted in excellent midterm functional outcomes [11].
  • The timing of fixation of displaced olecranon fractures does not significantly increase the rate of early complications or reoperation [13].
  • Olecranon fractures in the elderly have higher than expected 1 year mortality rates [14].
  • The median incidence of post-traumatic osteoarthritis following isolated olecranon fractures is 19% at a median follow-up of 41 months [20].
  • Suture fixation for simple olecranon fractures resulted in no re-operations or wound complications in the studied series [28].
  • Patients who have operative fixation of a fracture of the olecranon can be counseled that most patients keep their implants [61].
  • Only 3% of patients experience implant migration after operative fixation of a fracture of the olecranon [61].
  • 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 after olecranon fracture fixation [61].

Recovery

  • Non-operative treatment of olecranon fractures in patients aged ≥75 years provided excellent functional results at 6 months, without associated complications [1].
  • Nonoperative management of isolated displaced olecranon fractures in older, lower-demand patients yields satisfactory short-term and long-term outcomes [4].
  • 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 [21].
  • The literature on the treatment of olecranon fractures in elderly patients is limited [15].
  • Low-profile double-plate osteosynthesis is a safe and effective alternative treatment of olecranon fractures with excellent subjective and objective clinical outcome measures [2].
  • Plating of the olecranon leads to predictable union, though the most common complication was lack of full extension in 39% of patients [8].
  • Suture anchor fixation of displaced olecranon fractures resulted in excellent midterm functional outcomes [11].
  • 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 [43].
  • A majority of olecranon fractures heal uneventfully with good/excellent results with a small loss of motion to be expected [9].
  • Among active patients with a simple isolated, displaced fracture of the olecranon, no difference was found between tension-band wire (TBW) and plate fixation in the patient-reported outcome at 1 year following surgery [63].
  • The timing of fixation of displaced olecranon fractures does not significantly increase the rate of early complications or reoperation [13].
  • Patients with olecranon fractures have essentially similar demographic characteristics compared to patients with distal radius fractures [7].
  • Olecranon fractures in the elderly have higher than expected 1 year mortality rates [14].
  • The incidence of post-traumatic osteoarthritis following isolated olecranon fractures has a median incidence of 19% at a median follow-up of 41 months [20].

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] Low-profile double-plate osteosynthesis is a safe and effective alternative treatment of olecranon fractures with excellent subjective and objective clinical outcome measures. [2] (10.1016/j.otsr.2019.08.019)
  • [L3] The incidence of olecranon fractures increased by 29% over the 20-year study period. [3] (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. [4] (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. [5] (10.2106/jbjs.24.01097)
  • [L3] Both operative procedures effectively treat Mayo type II olecranon fractures. [6] (10.1186/s12891-025-08843-1)
  • [L3] Patients with olecranon fractures have essentially similar demographic characteristics compared to patients with distal radius fractures. [7] (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. [8] (10.1016/j.injury.2016.04.015)
  • [L4] A majority of olecranon fractures heal uneventfully with good/excellent results with a small loss of motion to be expected. [9] (10.1016/j.hcl.2015.07.003)
  • [L1] These data further support the role of primary non-operative management of isolated displaced fractures of the olecranon in the elderly. [10] (10.1302/0301-620x.99b7.bjj-2016-1112.r2)
  • [L4] Suture anchor fixation of displaced olecranon fractures resulted in excellent midterm functional outcomes. [11] (10.5397/cise.2023.00528)
  • [L3] More precise studies are needed in order to properly quantify the specific incidence of various subtypes of forearm and olecranon fractures and associated risk factors. [12] (10.1186/s12891-023-07162-7)
  • [L3] The timing of fixation of displaced olecranon fractures does not significantly increase the rate of early complications or reoperation. [13] (10.1016/j.jhsg.2023.09.002)
  • [L3] Olecranon fractures in the elderly have higher than expected 1 year mortality rates. [14] (10.1177/1758573221994860)
  • [L4] The literature on the treatment of olecranon fractures in elderly patients is limited. [15] (10.1007/s11678-018-0488-7)
  • [L4] Isolated fractures of the olecranon occur after a low-energy trauma, especially in older women (> 65 years). [16] (10.1007/s00068-021-01765-2)
  • [Paper] No one technique is suitable for the management of all olecranon fractures. [17] (10.1016/j.injury.2008.12.013)
  • [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. [18] (10.1186/s12891-015-0789-6)
  • [L4] Articular impaction is a common feature of geriatric olecranon fractures. [19] (10.5435/jaaos-d-20-01293)
  • [L4] This review identified a median OA incidence of 19% at a median follow-up of 41 months following isolated olecranon fractures. [20] (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. [21] (10.1177/1758573217711889)
  • [L4] In cases with concomitant injuries, the risk of limited elbow motion is high. [23] (10.1016/j.jse.2010.11.023)
  • [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. [24] (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. [25] (10.1007/s00590-015-1724-0)
  • [L3] Both implant types could be appropriate surgical techniques for fixation of selected olecranon fractures and osteotomies. [26] (10.1007/s00264-013-1854-0)
  • [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. [27] (10.1111/j.1758-5740.2012.00194.x)
  • [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. [28] (10.1177/1758573216687305)
  • [L5] Despite the complexities of this injury, an understanding of the relevant anatomy and the factors associated with elbow stability allows the application of a systematic algorithm for treatment that can help ensure sufficient elbow stability to allow early motion, thereby leading to improved outcomes in most patients. [29] (10.5435/00124635-200903000-00003)
  • [L5] MRCF effectively addresses the limitations of PRCF and provides stable, accurate measurements of rotational displacement even with varying elbow rotations. [30] (10.1186/s12891-024-08240-0)
  • [L5] The Mayo classification was designed to simplify categorization of olecranon fractures but does not achieve this goal due to poor reproducibility. [31] (10.1097/corr.0000000000000614)
  • [L1] Plate has better efficacy and safety for Mayo II olecranon fractures. [32] (10.1186/s13018-022-03262-7)
  • [L5] The study successfully created and validated an anatomic model of terrible triad of the elbow by exerting axial compression on an elbow in 15° flexion and maximal pronation at speeds of 100 and 10 mm/min. [33] (10.1186/s13018-024-05069-0)
  • [L3] Individuals with elbow degenerative changes had no inferior subjective elbow function compared to those with normal radiographs, except for those with joint space reduction. [34] (10.1007/s00402-020-03453-z)
  • [L4] The data suggest that elbow range of motion and functional use are maintained from comparison with short-term studies. [35] (10.1016/j.jse.2016.09.057)
  • [L5] The spin move is a simple maneuver that can improve exposure of the coronoid process regardless of the degree of elbow instability. [36] (10.1016/j.jse.2022.11.020)
  • [L4] Restoration of joint motion in the posttraumatic stiff elbow can be a difficult, time-consuming, and costly challenge. [37] (10.1016/j.jhsa.2007.09.015)
  • [L2] The study showed that OMC could be an effective alternative to treat olecranon fractures. [38] (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. [39] (10.1016/j.jhsa.2013.04.013)
  • [L1] This supports nonoperative treatment as a reasonable option for displaced stable olecranon fractures in elderly patients. [40] (10.2106/jbjs.24.00655)
  • [L5] Our results suggest that there is a portion of the aLTR that, despite being covered with articular cartilage, is non-articulating throughout normal elbow range of motion. [41] (10.2106/jbjs.18.01270)
  • [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. [42] (10.1302/2058-5241.5.190082)
  • [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. [43] (10.1016/j.jse.2007.02.092)
  • [L5] Evaluation and management of elbow injuries in young athletes requires knowledge of the immature developing anatomy, injury pathophysiology, and established treatment algorithms for each diagnosis. [44] (10.1016/j.csm.2010.06.010)
  • [L4] It is important to reconstruct the anterior capsule and ligamentous structures for providing stability to the elbow joint. [45] (10.1007/s00402-006-0198-2)
  • [L4] Good elbow function can be restored in most cases with minor impairments that do not worsen quality of life. [46] (10.1016/j.jse.2014.01.017)
  • [L4] Use of the surgical protocol restored sufficient elbow stability to allow early motion postoperatively, enhancing the functional outcome. [47] (10.2106/jbjs.d.02933)
  • [L5] Disruptions in any of these structures may lead to forearm instability with consequences at the remaining structures. [48] (10.1016/j.jhsa.2016.10.017)
  • [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. [49] (10.1177/1558944720944261)
  • [L4] Plate fixation of complex olecranon fracture is an effective, reliable method of treatment with low risk of non-union. [50] (10.1016/j.ijscr.2017.10.052)
  • [L3] OFD has the worst functional outcomes among complex elbow injury patterns. [51] (10.1016/j.jse.2024.06.004)
  • [L5] Proper treatment of coronoid fractures requires an understanding of the bony and soft tissue anatomy of the elbow and the various injury mechanisms that occur. [52] (10.1016/j.hcl.2004.07.004)
  • [L4] While ROM is typically preserved after reoperation and improved when the indication for reoperation is elbow stiffness, a significant proportion of patients (35%) experience subsequent complications. [53] (10.1016/j.jseint.2024.12.017)
  • [L3] Orthogonal plate configuration, olecranon osteotomy, and longer operative time were associated with increased odds of dysfunctional elbow stiffness. [54] (10.1016/j.jse.2024.06.010)
  • [L4] Specific patterns of traumatic elbow instability have correspondingly specific coronoid fracture patterns. [55] (10.1016/j.jhsa.2014.06.123)
  • [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. [56] (10.1016/j.ocl.2008.01.002)
  • [L4] Quantitative analysis of olecranon fractures further clarified fracture morphology of Mayo type I, II, and III fractures. [57] (10.1016/j.jse.2015.10.002)
  • [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. [58] (10.1016/j.xrrt.2025.08.004)
  • [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. [61] (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. [63] (10.2106/jbjs.16.00773)

References

[1] Results of non-operative treatment of olecranon fracture in over 75-year-olds. Orthopaedics & Traumatology: Surgery & Research. 2018. DOI: 10.1016/j.otsr.2017.10.015 [2] Clinical evaluation of double-plate osteosynthesis for olecranon fractures: A retrospective case-control study. Orthopaedics & Traumatology: Surgery & Research. 2019. DOI: 10.1016/j.otsr.2019.08.019 [3] Epidemiology and Treatment of Olecranon Fractures: a nationwide register-based analysis of 27,880 cases in Denmark from 1999 to 2018. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05970-2 [4] Nonoperative Management of Displaced Olecranon Fractures in Low-Demand Elderly Patients. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.l.01137 [5] Treatment of Displaced Olecranon Fractures in the Elderly: Should the Pendulum Swing?. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.01097 [6] Efficacy evaluation of Kirschner wire tension band combined with anatomical locking plate in the treatment of Mayo type II olecranon fractures. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08843-1 [7] Mortality and subsequent fractures of patients with olecranon fractures compared to other upper extremity osteoporotic fractures. Shoulder & Elbow. 2022. DOI: 10.1177/17585732221124301 [8] Outcomes after plating of olecranon fractures: A multicenter evaluation. Injury. 2016. DOI: 10.1016/j.injury.2016.04.015 [9] Olecranon Fractures. Hand Clinics. 2015. DOI: 10.1016/j.hcl.2015.07.003 [10] Prospective randomised trial of non-operativeversusoperative management of olecranon fractures in the elderly. The Bone & Joint Journal. 2017. DOI: 10.1302/0301-620x.99b7.bjj-2016-1112.r2 [11] Midterm outcomes of suture anchor fixation for displaced olecranon fractures. Clinics in Shoulder and Elbow. 2024. DOI: 10.5397/cise.2023.00528 [12] Trends and projection of forearm fractures including elbow fractures of the Olecranon in Sweden: an analysis of 363 968 fractures using public aggregated data. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-023-07162-7 [13] Timing of Olecranon Fracture Fixation Does Not Affect Early Complication or Reoperation Rates. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2023.09.002 [14] Complications and mortality associated with olecranon fractures in the elderly: a retrospective cohort comparison from a large level one trauma centre. Shoulder & Elbow. 2021. DOI: 10.1177/1758573221994860 [15] Nonoperative treatment of olecranon fractures in the elderly—a systematic review. Obere Extremität. 2018. DOI: 10.1007/s11678-018-0488-7 [16] Epidemiology, classification and treatment of olecranon fractures in adults: an observational study on 2462 fractures from the Swedish Fracture Register. European Journal of Trauma and Emergency Surgery. 2021. DOI: 10.1007/s00068-021-01765-2 [17] Olecranon fractures. Injury. 2009. DOI: 10.1016/j.injury.2008.12.013 [18] SOFIE: Surgery for Olecranon Fractures in the Elderly: a randomised controlled trial of operative versus non-operative treatment. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0789-6 [19] Incidence and Management of Articular Impaction in Geriatric Olecranon Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-20-01293 [20] Incidence of Post-traumatic Osteoarthritis in Olecranon Fractures and the Role of Instability and Comminution in its Development: A Systematic Review. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.02.024 [21] Pilot report: non-operative treatment of Mayo Type II olecranon fractures in any-age adult patient. Shoulder & Elbow. 2017. DOI: 10.1177/1758573217711889 [23] Results of open reduction and plate osteosynthesis in comminuted fracture of the olecranon. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.11.023 [24] Double Tension Band Wiring for Treatment of Olecranon Fractures. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.09.020 [25] Outcome after olecranon fracture repair: Does construct type matter?. European Journal of Orthopaedic Surgery & Traumatology. 2015. DOI: 10.1007/s00590-015-1724-0 [26] Locking-plate osteosynthesis versus intramedullary nailing for fixation of olecranon fractures: a biomechanical study. International Orthopaedics. 2013. DOI: 10.1007/s00264-013-1854-0 [27] Non-union of Non-operatively Treated Displaced Olecranon Fractures. Shoulder & Elbow. 2012. DOI: 10.1111/j.1758-5740.2012.00194.x [28] Tension band suture fixation for olecranon fractures. Shoulder & Elbow. 2017. DOI: 10.1177/1758573216687305 [29] Terrible Triad Injury of the Elbow: Current Concepts. Journal of the American Academy of Orthopaedic Surgeons. 2009. DOI: 10.5435/00124635-200903000-00003 [30] Elbow rotation affects the accuracy of rotational formulas: validation of a modified method. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-024-08240-0 [31] Classifications in Brief: Mayo Classification of Olecranon Fractures. Clinical Orthopaedics & Related Research. 2018. DOI: 10.1097/corr.0000000000000614 [32] Efficacy and safety of tension band wire versus plate for Mayo II olecranon fractures: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03262-7 [33] Creation of a replicable anatomic model of terrible triad of the elbow. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-05069-0 [34] Long-term outcomes after different types of Horne and Tanzer olecranon fractures. Archives of Orthopaedic and Trauma Surgery. 2020. DOI: 10.1007/s00402-020-03453-z [35] Hemiarthroplasty for the treatment of distal humeral fractures: midterm clinical results. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.09.057 [36] The spin move to facilitate antegrade coronoid fixation in terrible triad injuries. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2022.11.020 [37] The Posttraumatic Stiff Elbow: A Review of the Literature. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.09.015 [38] Design and application of Nickel-Titanium olecranon memory connector in treatment of olecranon fractures: a prospective randomized controlled trial. International Orthopaedics. 2013. DOI: 10.1007/s00264-013-1878-5 [39] Letter Regarding “Olecranon Fractures”. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.04.013 [40] Surgery for Olecranon Fractures in the Elderly (SOFIE). Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.00655 [41] Lateral Trochlear Ridge. Journal of Bone and Joint Surgery. 2019. DOI: 10.2106/jbjs.18.01270 [42] Paediatric olecranon fractures: a systematic review. EFORT Open Reviews. 2020. DOI: 10.1302/2058-5241.5.190082 [43] Long Term Outcome Of Surgically Treated Complex Olecranon Fractures. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2007.02.092 [44] Pediatric Sports Elbow Injuries. Clinics in Sports Medicine. 2010. DOI: 10.1016/j.csm.2010.06.010 [45] Reconstruction of the coronoid process with iliac crest bone graft in complex fracture-dislocation of elbow. Archives of Orthopaedic and Trauma Surgery. 2006. DOI: 10.1007/s00402-006-0198-2 [46] Results of parallel plate fixation of comminuted intra-articular distal humeral fractures. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.01.017 [47] Standard Surgical Protocol to Treat Elbow Dislocations with Radial Head and Coronoid Fractures. Journal of Bone and Joint Surgery. 2005. DOI: 10.2106/jbjs.d.02933 [48] Forearm Instability: Anatomy, Biomechanics, and Treatment Options. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2016.10.017 [49] Nonoperative Management of Olecranon Fractures in Elderly Patients: A Systematic Review. HAND. 2020. DOI: 10.1177/1558944720944261 [50] Management of type IIB and IIIB olecranon fractures. Case series. International Journal of Surgery Case Reports. 2017. DOI: 10.1016/j.ijscr.2017.10.052 [51] Three-dimensional quantitative study and functional outcome analysis of coronoid fracture in different elbow injury patterns. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.06.004 [52] Fractures of the coronoid process. Hand Clinics. 2004. DOI: 10.1016/j.hcl.2004.07.004 [53] Surgical outcomes after reoperation of intra-articular proximal ulna fractures. JSES International. 2025. DOI: 10.1016/j.jseint.2024.12.017 [54] Risk factors for dysfunctional elbow stiffness following operative fixation of distal humerus fractures. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.06.010 [55] Distribution of Coronoid Fracture Lines by Specific Patterns of Traumatic Elbow Instability. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.123 [56] Olecranon Fractures. Orthopedic Clinics of North America. 2008. DOI: 10.1016/j.ocl.2008.01.002 [57] Quantitative 3-dimensional computed tomography analysis of olecranon fractures. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.10.002 [58] Risk factors for complications and poor function after open reduction and fixation of olecranon fractures. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2025.08.004 [61] Factors Associated With Reoperation After Fixation of Displaced Olecranon Fractures. Clinical Orthopaedics & Related Research. 2016. DOI: 10.1007/s11999-015-4488-2 [63] Plate Versus Tension-Band Wire Fixation for Olecranon Fractures. Journal of Bone and Joint Surgery. 2017. DOI: 10.2106/jbjs.16.00773

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