Fratura do olécrano Folheto In-depth

O que você está sentindo

Uma fratura no olécrano é uma ruptura na ponta óssea do cotovelo, aquela parte que você consegue sentir na parte de trás do braço. Geralmente ocorre após uma queda sobre o cotovelo ou um impacto direto. Às vezes, um movimento brusco e forte de extensão do braço contra resistência faz com que um pedaço de osso se desprenda da ponta.

Imediatamente, você sentirá dor na parte de trás do cotovelo. A área costuma inchar bastante, e pode haver acúmulo de líquido sob a pele na região do cotovelo. Como esse osso fica bem próximo à superfície da pele, talvez seja possível sentir a fratura através do inchaço. O braço pode apresentar hematomas, e provavelmente você terá dificuldade ou relutância em dobrar ou esticar o cotovelo.

Se a fratura deslocar algum fragmento ósseo, torna-se difícil ou impossível esticar o braço contra a gravidade. O músculo na parte de trás do braço normalmente se fixa nessa ponta óssea; quando essa fixação se rompe, o músculo não consegue mais atuar adequadamente. Pode haver uma separação visível ou alteração na forma da parte de trás do cotovelo.

Nos primeiros dias, a dor costuma ser mais intensa durante os movimentos e à noite. Atividades simples, como pegar um copo, vestir-se ou apoiar-se no cotovelo, causam dor. Dormir com o braço afetado também é desconfortável.

Nas primeiras semanas, a dor diminui gradualmente à medida que o osso começa a se consolidar. É comum haver alguma rigidez, e pode permanecer uma pequena perda da capacidade de esticar totalmente o braço mesmo após a cicatrização. A maioria das fraturas cicatriza sem problemas.

O seu cirurgião examinará todo o braço, desde o ombro até a mão, pois o cotovelo fica logo abaixo da pele e esta também pode ter sofrido lesões. Radiografias em dois ângulos geralmente mostram a fratura claramente. Em casos mais complexos, uma tomografia computadorizada — exame mais detalhado — pode revelar melhor o padrão dos fragmentos ósseos, embora não seja necessária na maioria dos casos.

Caso o cotovelo também tenha sofrido luxação além da fratura, novas radiografias são feitas após o reposicionamento do osso.

O que realmente acontece

A ponta do cotovelo é um único pedaço de osso que funciona como uma “tampa de dobradiça”. Ele envolve uma extremidade do osso do braço acima dele e desliza num sulco nesse local ao dobrarmos ou esticarmos o braço. Essa ponta óssea também serve como ponto de fixação para o tendão do músculo localizado na parte de trás do braço, responsável por esticar o cotovelo.

Como esse osso fica bem debaixo da pele, sem muita cobertura, um golpe ou uma queda podem facilmente causar sua fratura. Quando isso ocorre, o tendão continua puxando o fragmento ósseo quebrado. Esse puxão desloca o fragmento para cima e para fora de seu lugar original, deixando um vazio na superfície articular lisa. Com esse ponto de fixação rompido, o músculo não consegue mais esticar o cotovelo contra a gravidade. Imagine uma dobradiça de porta na qual um pedaço do mecanismo de acionamento se quebrou: a dobradiça ainda pode mover-se, mas o mecanismo não tem mais nada sólido para segurar.

A fratura em si cicatriza da mesma forma que qualquer outra fratura óssea: as duas extremidades se unem por meio da formação de novo osso ao longo de semanas. Porém, se um fragmento se deslocou de seu lugar original, ele precisa ser mantido imóvel e próximo ao restante do osso para que essa união ocorra; às vezes, isso exige o uso de placas, fios ou pontos resistentes para fixá-lo.

Nem todas as fraturas são iguais. Algumas são apenas rachaduras, mas o osso permanece alinhado. Outras resultam em deslocamento do fragmento. Há ainda casos em que a própria articulação do cotovelo fica instável. Fraturas que permanecem alinhadas geralmente se resolvem sem cirurgia, enquanto aquelas com deslocamento, fragmentação múltipla ou instabilidade articular normalmente exigem intervenção cirúrgica para recolocação e fixação do osso.

Na maioria dos casos, essas fraturas ocorrem isoladamente; porém, a mesma queda pode lesionar outras partes do braço, e o osso pode rasgar a pele sobre o cotovelo. O cirurgião avaliará ambas as situações.

O que podemos fazer a respeito

O Dr. Kieran Hirpara, cirurgião de membros superiores no Mater Private Hospital Rockhampton, adapta o tratamento à sua lesão específica. Em geral, os pacientes são encaminhados à nossa clínica pelo médico de família; caso um fisioterapeuta tenha sugerido que nos procurasse, ainda assim será necessário um encaminhamento do seu médico de família para que você tenha direito ao reembolso do Medicare. Na primeira consulta, colhemos o histórico clínico, examinamos o seu braço e, quando necessário, utilizamos radiografias ou tomografia computadorizada para determinar o padrão da fratura.

Algumas fraturas permanecem alinhadas ou quase não se deslocam; além disso, algumas pessoas apresentam outros problemas de saúde que tornam a cirurgia pouco indicada. Nesses casos, podemos sugerir o tratamento sem intervenção cirúrgica. Geralmente isso envolve o uso de uma tipóia, talas ou gesso para manter o cotovelo imóvel enquanto o osso se consolida, com radiografias de acompanhamento para garantir que nada tenha se deslocado. A mobilidade é gradualmente restaurada por meio de fisioterapia, assim que a fratura estiver pronta para isso. Esse método é especialmente adequado para idosos e pessoas menos ativas; ele pode ser eficaz mesmo quando a fratura está ligeiramente deslocada.

Outras fraturas exigem cirurgia desde o início. Quando o fragmento ósseo se deslocou bastante, quando a articulação do cotovelo está instável ou quando a fratura está dividida em vários pedaços, a operação serve para recolocar os fragmentos e fixá-los, permitindo que o osso se consolide na posição correta. A fixação também precisa ser suficientemente resistente para permitir que o paciente comece a movimentar o cotovelo precocemente, o que ajuda a evitar a rigidez articular. A maioria das pessoas submetidas à cirurgia para esse tipo de fratura tem bons resultados; porém, é comum haver uma pequena perda na capacidade de estender totalmente o braço, e, às vezes, os implantes metálicos precisam ser removidos posteriormente por causarem desconforto. A decisão é realmente compartilhada: para algumas fraturas em idosos, ambos os tratamentos podem ser eficazes, e a escolha depende do quanto de desconforto você está disposto a suportar e do resultado final desejado para o seu cotovelo.

Independentemente do caminho escolhido, as primeiras semanas são semelhantes. O controle da dor mantém o conforto do paciente enquanto o inchaço diminui. Você deve proteger o braço enquanto o osso se consolida, respeitando os limites que indicarmos. A fisioterapia é iniciada na fase adequada à sua lesão, visando restaurar gradualmente a mobilidade. Acompanhamos seu progresso para garantir que a fratura esteja cicatrizando conforme o esperado.

O que esperar

A maioria dessas fraturas cicatriza bem. O osso se consolida ao longo de várias semanas, e a dor diminui naturalmente. A maioria das pessoas acaba com um cotovelo funcional; porém, uma pequena perda da capacidade de esticar completamente o braço é comum e geralmente não gera grandes problemas na vida cotidiana.

Se a fratura for tratada sem cirurgia, você usará uma tipoia, talas ou gesso enquanto o osso se consolida, além de realizar radiografias de acompanhamento para garantir que nada se desloque. Em idosos que seguem esse tratamento, a funcionalidade do cotovelo costuma ser boa após seis meses, e a fratura pode cicatrizar sem complicações. O principal risco é que os fragmentos ósseos se movam antes de se unirem; por isso, monitoramos o caso de perto.

Na cirurgia, os fragmentos são fixados firmemente para que o osso se consolide na posição correta; a colocação de placas garante uma cicatrização confiável. A maioria dos pacientes consegue movimentar o cotovelo e realizar tarefas diárias em poucas semanas; a fisioterapia contribui para uma recuperação ainda maior nos meses seguintes. A longo prazo, 96% das pessoas com fraturas deslocadas tratadas dessa forma relatam boa ou muito boa funcionalidade do cotovelo; esses resultados foram acompanhados por até 25 anos após a lesão.

A recuperação nem sempre é tranquila. O problema mais comum após a cirurgia é a incapacidade de esticar totalmente o cotovelo; isso ocorre em 39% dos pacientes que recebem placas. O material metálico fica logo abaixo da pele e, às vezes, causa desconforto suficiente para ser removido posteriormente. A falta de movimentação do cotovelo pode levar ao endurecimento articular, e a artrose pode surgir anos após a lesão, especialmente quando a fratura envolveu vários fragmentos.

Em crianças, as fraturas tratadas sem cirurgia exigem acompanhamento radiográfico rigoroso, pois os fragmentos podem se deslocar após o início do tratamento. Uma fratura infantil geralmente faz parte de uma lesão mais complexa ao redor do cotovelo; por isso, todo o braço precisa ser examinado cuidadosamente.

Os idosos enfrentam riscos adicionais além do próprio cotovelo. Fraturas desse tipo em idosos apresentam taxas de mortalidade no primeiro ano acima do esperado; esse é um dos motivos pelos quais avaliamos cuidadosamente a cirurgia em relação a outros problemas de saúde antes de recomendar qualquer tratamento.

Quando procurar ajuda médica

Procure atendimento urgente se o cotovelo parecer deformado, se a pele estiver ferida, se houver dormência ou formigamento, ou se você não conseguir usar o braço de forma alguma. Para a maioria dos outros tipos de fraturas, comece consultando seu médico de família, que poderá solicitar radiografias e encaminhá-lo a um especialista, se necessário. Após o início do tratamento, fique atento à evolução do quadro semanalmente. Consulte seu médico de família ou peça uma avaliação especializada caso a dor não diminua, ou se o inchaço, a amplitude de movimento e a capacidade de realizar atividades diárias não apresentarem melhora de uma semana para outra, à medida que o osso cicatriza. Confie no que você percebe: uma evolução lenta é normal, mas a ausência total de progresso merece ser avaliada.

Em maior profundidade

Advanced reading: the deeper science (optional)

Esta seção vai além do que você precisa saber para tomar decisões sobre o próprio tratamento. A fratura do olécrano merece uma leitura mais aprofundada devido a uma constatação que inverte a lógica habitual da cirurgia de fraturas: em pacientes idosos, uma fratura deslocada do olécrano pode ser deixada sem fixação, e o cotovelo continua funcionando normalmente.

A fratura deslocada que não precisa de correção

Uma fratura no olécrano separa o tríceps do antebraço; por isso, a lógica convencional é de que ela deve ser reimplantada, caso contrário o cotovelo não conseguirá ser estendido contra resistência. Em pacientes com mais de 70 anos, essa lógica não se aplica. Uma revisão sistemática constatou que fraturas deslocadas do olécrano nesse grupo podem ser tratadas de forma não cirúrgica, com alto grau de satisfação do paciente e manutenção de uma amplitude de movimento funcional [1].

O que se perde nesse tratamento é mensurável: déficit na extensão do cotovelo, incapacidade de estender completamente o membro e redução da força de extensão. O que se evita, por outro lado, é a formação de ferida sobre um osso subcutâneo em pele fina e frequentemente frágil, além da necessidade de implantar materiais metálicos sob essa pele. Como o uso de implantes é a causa mais comum de uma segunda cirurgia após a fixação do olécrano, evitá-los elimina por completo essa complicação frequente.

Para um idoso cujo braço é utilizado para tarefas cotidianas, e não para esforços de empuxo intensos, um cotovelo que não consegue atingir os últimos graus de extensão representa um incômodo menor do que as complicações decorrentes de feridas. Para um paciente mais jovem ou com demandas físicas maiores, isso não se aplica; por isso, essa abordagem é indicada especificamente para idosos, e não de forma geral.

Naqueles casos em que a fixação é necessária, a escolha do implante faz diferença

Para o padrão comum de fraturas deslocadas, porém simples, dois tipos de implantes competem: a estrutura de fios de tensão e a placa óssea. Em 827 pacientes com fraturas do tipo II segundo a classificação de Mayo, a fixação com placa demonstrou maior eficácia e segurança em comparação com o uso de fios de tensão; os autores ressaltam, porém, que poucos estudos foram incluídos e que ainda são necessários ensaios randomizados de maior qualidade [2]. Uma revisão de 2025 envolvendo 472 pacientes, que comparou técnicas modernas de fixação com os métodos tradicionais de fios de tensão, chegou à mesma conclusão [3].

Este é um dos poucos casos neste site em que a comparação entre técnicas aponta para uma direção clara, em vez de deixar a questão em aberto. Contudo, vale considerar essa conclusão com cautela, dado o próprio nível de evidência apontado pelos autores.

A artrite se desenvolve, mas, na maioria dos casos, não é um problema

Os achados de exames de imagem a longo prazo podem ser alarmantes quando apresentados sem contexto. Após fraturas isoladas do olécrano, a incidência média de osteoartrite pós-traumática foi de 19%, em um seguimento médio de 41 meses; além disso, os resultados relatados pelos pacientes variaram de bons a excelentes, independentemente do tipo de fratura ou da presença de artrite [4].

Ambas as partes dessa frase são essenciais para a compreensão do tema. A artrite observada em radiografias de acompanhamento após essa lesão é comum. Contudo, nesse período de tempo, ela praticamente não influencia a forma como os pacientes avaliam a função do cotovelo. Um achado radiológico não equivale automaticamente a um problema clínico, e por si só não deve ser motivo para intervenções adicionais.

Referências

[1] Alvara CA, Biedron G, Dunn JC. Tratamento não cirúrgico de fraturas do olécrano em pacientes idosos: uma revisão sistemática. Hand (N Y). 2020;17(4):734-9. https://doi.org/10.1177/1558944720944261

[2] Jia Y, Liu A, Guo T, Chen J, Yu W, Zhai J. Eficácia e segurança do fio de tensão em comparação com placa para fraturas do olécrano tipo Mayo II: uma revisão sistemática e meta-análise. J Orthop Surg Res. 2022;17(1). https://doi.org/10.1186/s13018-022-03262-7

[3] Wang C, Li C. Técnicas modernas de fixação versus o método tradicional de fio de tensão para fraturas do olécrano: uma revisão sistemática e meta-análise. J Orthop Surg Res. 2025;20(1). https://doi.org/10.1186/s13018-025-06061-y

[4] Wiersma JP, de Klerk HH, Priester-Vink S, Doornberg JN, Bhasyam AR, van den Bekerom MP. Incidência de osteoartrite pós-traumática em fraturas do olécrano e o papel do tipo de fratura: uma revisão sistemática. J Shoulder Elbow Surg. 2026. https://doi.org/10.1016/j.jse.2026.02.024

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Close radiographic follow-up is recommended for nonsurgically treated olecranon fractures in children [1].
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 [2].
A majority of olecranon fractures heal uneventfully with good or excellent results, with a small loss of motion to be expected [4].
Low-profile double-plate osteosynthesis is a safe and effective alternative treatment of olecranon fractures with excellent subjective and objective clinical outcome measures [5].
Satisfactory short-term and long-term outcomes were found following the nonoperative management of isolated displaced olecranon fractures in older, lower-demand patients [7].
Future studies should focus on the long-term outcomes of suture tension band fixation as compared to traditional and more established techniques to treat olecranon fractures [8].
Both Kirschner wire tension band and anatomical locking plate operative procedures effectively treat Mayo type II olecranon fractures [11].
Plating of the olecranon leads to predictable union, though the most common complication was lack of full extension in 39% of patients [19].
The timing of fixation of displaced olecranon fractures does not significantly increase the rate of early complications or reoperation [24].
Tension-band wiring remains an effective treatment for appropriately selected olecranon fractures and outperformed plate osteosynthesis in the studied cohort [34].
Surgical treatment of olecranon fractures is associated with a high rate of complications [63].
Patients undergoing revisions beyond implant removal had poorer functional outcomes after surgical treatment of olecranon fractures [63].
No significant differences in functional outcomes or secondary operations were found with respect to fracture type, gender, or surgical method in the treatment of olecranon fractures [63].

Anatomy & Pathophysiology

Bony Anatomy

The olecranon and the coronoid process form the greater sigmoid notch, which articulates with the trochlea of the distal humerus [21].
The intrinsic anatomy of the ulnohumeral articulation allows flexion/extension movement of the elbow joint and provides stability for the elbow [21].
The olecranon serves as the insertion for the triceps tendon, which blends with the periosteum of the proximal ulna [21].
The exposed, subcutaneous position of the olecranon renders it vulnerable to direct trauma and violent muscular contractions from the triceps [21].
In children, the olecranon is predominantly cartilage, particularly in younger patients, which reduces the likelihood of fracture from a direct blow [29].
In children, the thick periosteum and relatively thin metaphyseal cortex of the olecranon predispose the bone to minimally displaced greenstick fractures [29].

Mechanisms of Injury

Olecranon fractures can result from a direct blow, a fall on an outstretched hand with the elbow in flexion, or high-energy trauma associated with radial head fractures or elbow dislocation [21].
Sudden and violent triceps muscle contraction can produce an avulsion fracture of varying size at the olecranon tip [21].
A bimodal distribution of olecranon fractures is observed in young patients with high-energy trauma and elderly patients with low-energy trauma such as a fall from standing [21].
In older patients, olecranon fractures typically occur as low-energy falls from standing, while in younger patients they typically occur via high-energy injury mechanisms [22].
Regardless of the mechanism of injury, the triceps acts as the main deforming mechanism pulling the fractured fragment proximally, creating a gap at the articular surface and an incompetent extensor mechanism [22].
In pediatric patients, olecranon fractures are usually the result of a hyperextension injury [29].
Pediatric olecranon fractures may also be caused by a direct blow to the flexed elbow, hyperflexion injury, or shear force [29].
Valgus hyperextension forces in pediatric patients may produce an associated radial neck or medial epicondyle fracture [29].
Varus hyperextension injuries in pediatric patients may be associated with lateral dislocation of the radial head or a Bado type III Monteggia lesion [29].
Flexion injuries in pediatric patients are usually caused by a fall on an outstretched hand with the elbow flexed, resulting from a strong eccentric contraction of the triceps [29].
Pediatric flexion injuries are generally transverse (perpendicular to the axis of the ulna), displaced posteriorly rather than anteriorly, and rarely associated with other injuries [29].
Shear injuries in pediatric patients 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 [29].

Associated Injuries and Epidemiology

Olecranon fractures account for approximately 5% of elbow fractures in pediatric patients [29].
Pediatric olecranon fractures are associated with other elbow injuries, usually the medial epicondyle, in 20% to 50% of cases [29].
In adults, olecranon fractures typically occur in isolation, but 22% of patients had injuries to the ipsilateral limb and 6.4% of fractures were open in one epidemiologic study [22].
Olecranon fractures compose approximately 10% of all fractures around the elbow [32].
In a Swedish Fracture Register study of 2,462 fractures, 29% were comminuted central fractures and the share of distal olecranon fractures was almost threefold larger than the 6.2% reported in a Scottish study [9].
In the Swedish Fracture Register study, 87.4% of female patients and 77.8% of male patients overall sustained low-energy injuries [9].

Fracture Patterns and Classification

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 [22].
The Mayo classification of olecranon fractures is based on the amount of fracture displacement, the presence of comminution, and stability of the ulnohumeral joint [22].
In the Mayo classification, Type I fractures are nondisplaced, Type II fractures are displaced, and Type III fractures have an unstable ulnohumeral joint [22].
The modifier A (simple) and B (comminuted) in the Mayo classification indicate the presence of comminution [22].
The Schatzker and Colton classification attempted to classify olecranon fractures based on different fracture pattern morphology, but its application was limited [22].
A proposed fragment-specific classification system for complex olecranon fractures is anatomically based and considers the deforming forces from ligaments and tendons [36].

Classification

Epidemiology and Demographics

The incidence of olecranon fractures increased by 29% over a 20-year study period in Denmark [6].
Olecranon fractures show a bimodal distribution, occurring in younger patients due to high-energy trauma and in elderly cohorts with low bone quality after low-energy falls [60].
In a Swedish study of 2,462 fractures, high-energy injuries were more common in males (11.6%) than females (5.7%), while low-energy injuries were more common in females (87.4%) than males (77.8%) [9].
In a UK study of 64 olecranon fractures, the mean age was 57 years, with males fracturing at a significantly younger mean age (50 years) than females (63 years) [66].
Patients with olecranon fractures have essentially similar demographic characteristics compared to patients with distal radius fractures [12].
More precise studies are needed to properly quantify the specific incidence of various subtypes of forearm and olecranon fractures and associated risk factors [15].

Classification Systems

The Mayo classification is the most commonly used in clinical practice for olecranon fractures [28].
The Mayo classification consists of 3 types, with a modifier to indicate comminution [28].
In the Mayo classification, Type I fractures are nondisplaced, Type II fractures are displaced, and Type III fractures have accompanying injuries [28].
The Mayo classification specifically accounts for fracture stability as well as comminution [27].
In the Mayo classification, Type 1 is not displaced and stable, Type 2 is displaced but stable, and Type 3 is displaced and unstable [27].
Each Mayo type can be subdivided into subtype A (non-comminuted) or B (comminuted) [27].
The Mayo classification was designed to simplify categorization of olecranon fractures but does not achieve this goal due to poor reproducibility [38].
Multiple classification systems for olecranon fractures exist, including AO, Mayo, Schatzker and Colton, but none are widely accepted or provide direct and reliable advice on operative strategies [60].
The low reproducibility rates of olecranon fracture classification systems raise questions about their use in clinical and research contexts [60].
Schatzker and Colton divide olecranon fractures into groups by quantity of fragments and fracture lines [60].
The AO classification subsumes olecranon fractures to proximal forearm injuries [60].
Quantitative analysis of olecranon fractures further clarified fracture morphology of Mayo type I, II, and III fractures [57].
A proposed novel classification system for complex olecranon fractures is anatomically based and considers the deforming forces from ligaments and tendons [36].

Fracture Patterns and Distribution

In a Swedish study of 2,462 fractures, comminuted central fractures accounted for 29% of cases [9].
The share of distal olecranon fractures in a Swedish nationwide study was almost threefold larger than the 6.2% reported in a Scottish single-center study [9].
In a UK study of 64 olecranon fractures, the most frequent injury according to the AO fracture classification was the 21-B1.1 type [66].
In a UK study of 64 olecranon fractures, a simple isolated displaced olecranon fracture (Mayo type 2A) was the most common according to the Mayo classification [66].
In a UK study of 64 olecranon fractures, Mayo type 2A fractures accounted for 73.5% of cases [66].
In a UK study of 64 olecranon fractures, Mayo type 1A fractures accounted for 12.5% of cases [66].
In a UK study of 64 olecranon fractures, Mayo type 2B fractures accounted for 7.8% of cases [66].
In a UK study of 64 olecranon fractures, Mayo type 3A and 3B fractures each accounted for 3.1% of cases [66].
Fracture of the olecranon in a child is often only part of a complex injury to the bone and soft tissues around the elbow [16].

Clinical Presentation

Mechanisms and Epidemiology

Sudden and violent triceps muscle contraction can produce an avulsion fracture of varying size of the olecranon tip [21].
A bimodal distribution of olecranon fractures is seen in young patients with high-energy trauma and elderly patients with low-energy trauma such as a fall from standing [21].
The incidence of olecranon fractures increased by 29% over the 20-year study period from 1999 to 2018 in Denmark [6].
In a Swedish study of patients aged 65 years and below, high-energy injury mechanisms accounted for 10.3% of female and 15.9% of male cases, while low-energy mechanisms accounted for 81.8% of female and 73.2% of male cases [9].
In a Swedish study of patients older than 65 years, high-energy injury mechanisms accounted for 2.4% of female and 4.1% of male cases, while low-energy mechanisms accounted for 91.2% of female and 85.8% of male cases [9].
Olecranon fractures in the elderly have higher than expected 1 year mortality rates [25].

Physical Examination

Pain is usually localized to the posterior part of the elbow [21].
Given the subcutaneous location of the olecranon, the fracture itself may be palpable [21].
Extensive posterior swelling is typical [21].
A careful examination of the integrity of the extensor mechanism with gravity eliminated can aid surgical decision making [21].
Open wounds, if present, are typically posterior and result from the direct impact of the posterior surface of the elbow against an unyielding structure [21].
The affected extremity from shoulder to hand should be thoroughly examined due to a significant incidence of associated ipsilateral injuries [22].
The arm should be examined for soft tissue compromise, and clinicians should have a low suspicion for open fractures given the subcutaneous nature of the olecranon [22].
The elbow will often present with a large fluid collection subcutaneously over the olecranon [22].
Examination of the extensor mechanism both with and without gravity eliminated should be performed to assess competency [22].
In an epidemiologic study, 22% of patients with olecranon fractures had injuries to the ipsilateral limb and 6.4% of fractures were open [22].
Olecranon fractures in children are usually undisplaced and incomplete, with the 'longitudinal split' fracture being not uncommon [20].

Imaging

Plain radiographs are usually sufficient for isolated fractures of the olecranon [21].
A true lateral radiograph is necessary to accurately identify the plane of the fracture and the number of fracture fragments [21].
The examiner should assess for fracture comminution and impaction on radiographs [21].
In more complex cases, CT may help delineate comminution or impaction better, but this is not routinely required [21].
Anteroposterior and lateral radiographs of the elbow are required for olecranon fractures [22].
If there is concern for a radial head fracture, a radiocapitellar view of the elbow can be obtained [22].
In the setting of an elbow dislocation, post-reduction radiographs should be obtained [22].
Computed tomography (CT) can be used for preoperative planning for comminuted fractures of the olecranon if there is an associated radial head or coronoid fracture, but this is not routinely utilized [22].
Articular impaction is a common feature of geriatric olecranon fractures [50].

Classification

The Mayo classification is the most common classification used for olecranon fractures [22].
The Mayo classification is based on the amount of fracture displacement, the presence of comminution, and stability of the ulnohumeral joint [22].
The Mayo classification is simple to use, can help guide fracture management, and has good interobserver reliability [22].
Displaced olecranon fracture lines entered along the medial side of the trochlear notch and exited at the base of the coronoid, while minimally displaced fractures entered and exited the trochlear notch at the base of the coronoid [22].
In a Swedish study, 29% of olecranon fractures were comminuted central fractures [9].
The share of distal olecranon fractures in the Swedish study was almost threefold larger than the 6.2% reported in a Scottish study of 64 olecranon fractures [9].

Investigations

Imaging

In more complex cases, CT may help delineate the comminution or impaction better, but this is not routinely required [21].
Radiographic evaluation generally analyzes the fracture based on the percentage of articular surface involved in the fractured proximal fragment [32].
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 [32].

Physical Examination

If present, open wounds are typically posterior and result from the direct impact of the posterior surface of the elbow against an unyielding structure [21].
The affected extremity from shoulder to hand should be thoroughly examined [22].
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 [22].
Pain usually is localized to the posterior part of the elbow [21].
The history may help distinguish a triceps avulsion from an actual direct blow to the elbow [21].

Classification

The Colton classification system can aid in decision making regarding treatment options [21].
In a Swedish study of 2,462 fractures, the distribution of fractures differed compared to a single-center report from Scotland, with a larger share of comminuted central fractures (29%) [9].
The Swedish study observed an almost threefold larger share of distal olecranon fractures than the 6.2% reported in the Scottish study of 64 olecranon fractures [9].

Treatment

Non-Operative Management

Some isolated displaced (>2 mm) olecranon fractures in elderly patients can be successfully treated nonoperatively [3].
The literature on the treatment of olecranon fractures in elderly patients is limited [26].
Nonoperative treatment is supported as a reasonable option for displaced stable olecranon fractures in elderly patients [49].
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 [53].

Operative Management

Fixation must be secure enough to permit early motion to avoid significant stiffness of the elbow joint [10].
Both operative procedures (Kirschner wire tension band combined with anatomical locking plate) effectively treat Mayo type II olecranon fractures [11].
No one technique is suitable for the management of all olecranon fractures [18].
The majority of olecranon fractures are treated surgically [28].
Good results overall are to be expected after surgical management of olecranon fractures [28].
Tension band wiring (TBW) remains an effective treatment for appropriately selected olecranon fractures and outperformed plate osteosynthesis in the studied cohort [34].
Plate fixation has better efficacy and safety for Mayo II olecranon fractures [42].
Nickel-Titanium olecranon memory connector (OMC) can be an effective alternative to treat olecranon fractures [47].
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) [51].
Low-profile double-plate osteosynthesis for treating olecranon fractures resulted in good clinical outcomes [58].

Outcomes and General Considerations

Although some loss of range of motion is common, good results overall are to be expected after surgical management [28].
Symptomatic hardware requiring removal is a recurring and frequent problem in olecranon fracture treatment [28].

Complications

General Outcomes and Mortality

Hardware and Surgical Complications

Symptomatic hardware requiring removal is a recurring and frequent problem following surgical management of olecranon fractures [28].

Joint Degeneration and Motion

The incidence of ulnohumeral osteoarthritis following isolated olecranon fractures is assessed using classifications such as Broberg and Morrey, where grade 1 or higher is considered to have osteoarthritis [27].
The role of comminution in the development of ulnohumeral osteoarthritis is assessed by comparing non-comminuted (type A) with comminuted (type B) fractures [27].
The role of instability in the development of ulnohumeral osteoarthritis is assessed by comparing displaced but stable (type 2) with displaced and unstable (type 3) fractures [27].

Pediatric and Specific Populations

Close radiographic follow-up for nonsurgically treated olecranon fractures is recommended in children to monitor for further displacement [1].

Recovery

The incidence of ulnohumeral osteoarthritis following isolated olecranon fractures was determined using the Broberg and Morrey classification, where grade 1 or higher is considered to have osteoarthritis [27].
The role of comminution in the development of ulnohumeral osteoarthritis was assessed by comparing Mayo type A (non-comminuted) with type B (comminuted) fractures [27].
The role of instability in the development of ulnohumeral osteoarthritis was assessed by comparing Mayo type 2 (displaced but stable) with type 3 (displaced and unstable) fractures [27].

Key Evidence

[L4] Close radiographic follow-up for nonsurgically treated olecranon fractures is recommended. [1] (10.5435/jaaos-d-25-00821)
[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. [2] (10.1067/mse.2002.124548)
[L4] Some isolated displaced (>2 mm) olecranon fractures in elderly patients can be successfully treated nonoperatively. [3] (10.1016/j.ocl.2016.08.011)
[L4] A majority of olecranon fractures heal uneventfully with good/excellent results with a small loss of motion to be expected. [4] (10.1016/j.hcl.2015.07.003)
[L3] Low-profile double-plate osteosynthesis is a safe and effective alternative treatment of olecranon fractures with excellent subjective and objective clinical outcome measures. [5] (10.1016/j.otsr.2019.08.019)
[L3] The incidence of olecranon fractures increased by 29% over the 20-year study period. [6] (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. [7] (10.2106/jbjs.l.01137)
[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. [8] (10.1016/j.jseint.2026.101734)
[L4] [9] (10.1007/s00068-021-01765-2)
[L5] Fixation must be secure enough to permit early motion to avoid significant stiffness of the elbow joint. [10] (10.5435/00124635-200007000-00007)
[L3] Both operative procedures effectively treat Mayo type II olecranon fractures. [11] (10.1186/s12891-025-08843-1)
[L3] Patients with olecranon fractures have essentially similar demographic characteristics compared to patients with distal radius fractures. [12] (10.1177/17585732221124301)
[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. [15] (10.1186/s12891-023-07162-7)
[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. [16] (10.1016/0020-1383(80)90009-1)
[Paper] No one technique is suitable for the management of all olecranon fractures. [18] (10.1016/j.injury.2008.12.013)
[L3] Plating of the olecranon leads to predictable union, though the most common complication was lack of full extension in 39% of patients. [19] (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. [20] (10.1016/0020-1383(75)90056-x)
[L3] The timing of fixation of displaced olecranon fractures does not significantly increase the rate of early complications or reoperation. [24] (10.1016/j.jhsg.2023.09.002)
[L3] Olecranon fractures in the elderly have higher than expected 1 year mortality rates. [25] (10.1177/1758573221994860)
[L4] The literature on the treatment of olecranon fractures in elderly patients is limited. [26] (10.1007/s11678-018-0488-7)
[L4] [27] (10.1016/j.jse.2026.02.024)
[L4] [28] (10.1016/j.jhsa.2012.12.036)
[L4] TBW remains an effective treatment for appropriately selected olecranon fractures and in this cohort outperformed plate osteosynthesis. [34] (10.1007/s00590-015-1724-0)
[L4] This proposed classification system is anatomically based and considers the deforming forces from ligaments and tendons. [36] (10.1016/j.jse.2023.12.021)
[L5] The Mayo classification was designed to simplify categorization of olecranon fractures but does not achieve this goal due to poor reproducibility. [38] (10.1097/corr.0000000000000614)
[L1] Plate has better efficacy and safety for Mayo II olecranon fractures. [42] (10.1186/s13018-022-03262-7)
[L2] The study showed that OMC could be an effective alternative to treat olecranon fractures. [47] (10.1007/s00264-013-1878-5)
[L1] This supports nonoperative treatment as a reasonable option for displaced stable olecranon fractures in elderly patients. [49] (10.2106/jbjs.24.00655)
[L4] Articular impaction is a common feature of geriatric olecranon fractures. [50] (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. [51] (10.1177/147323001204000324)
[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. [53] (10.1177/1558944720944261)
[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)
[L3] Low-profile double-plate osteosynthesis for treating olecranon fractures resulted in good clinical outcomes. [58] (10.1016/j.jse.2020.01.091)
[L4] [60] (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. [63] (10.1016/j.xrrt.2025.08.004)
[L3] [66] (10.1016/j.injury.2011.10.017)

References

[1] Further Displacement After Initial Nonsurgical Treatment of Minimally Displaced Olecranon Fractures in Children. Journal of the American Academy of Orthopaedic Surgeons. 2026. DOI: 10.5435/jaaos-d-25-00821

[2] Comparison of tension-band and figure-of-eight wiring techniques for treatment of olecranon fractures. Journal of Shoulder and Elbow Surgery. 2002. DOI: 10.1067/mse.2002.124548

[3] Controversies in Fractures of the Proximal Ulna. Orthopedic Clinics of North America. 2017. DOI: 10.1016/j.ocl.2016.08.011

[4] Olecranon Fractures. Hand Clinics. 2015. DOI: 10.1016/j.hcl.2015.07.003

[5] 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

[6] 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

[7] Nonoperative Management of Displaced Olecranon Fractures in Low-Demand Elderly Patients. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.l.01137

[8] Suture tension band fixation reduces hardware complications in olecranon fractures: a comparative study. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101734

[9] 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

[10] Olecranon Fractures: Treatment Options. Journal of the American Academy of Orthopaedic Surgeons. 2000. DOI: 10.5435/00124635-200007000-00007

[11] 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

[12] Mortality and subsequent fractures of patients with olecranon fractures compared to other upper extremity osteoporotic fractures. Shoulder & Elbow. 2022. DOI: 10.1177/17585732221124301

[15] 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

[16] Fractures of the olecranon in children. Injury. 1980. DOI: 10.1016/0020-1383(80)90009-1

[18] Olecranon fractures. Injury. 2009. DOI: 10.1016/j.injury.2008.12.013

[19] Outcomes after plating of olecranon fractures: A multicenter evaluation. Injury. 2016. DOI: 10.1016/j.injury.2016.04.015

[20] Olecranon fractures in children. Injury. 1975. DOI: 10.1016/0020-1383(75)90056-x

[21] Aaos Comprehensive Orthopaedic Review 3. Fractures of the Elbow > II. Olecranon Fractures.

[22] Rockwood And Green S Fractures In Adults. 40: Fractures of the Proximal Forearm: Olecranon, Proximal Radius, and Radial Head > Assessment of Olecranon Fractures.

[24] 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

[25] 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

[26] Nonoperative treatment of olecranon fractures in the elderly—a systematic review. Obere Extremität. 2018. DOI: 10.1007/s11678-018-0488-7

[27] 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

[28] Olecranon Fractures. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.12.036

[29] Tachdjian S Pediatric Orthopaedics From The Texas Scottish Rite Hospital For Children E Book. Pigmented Villonodular Synovitis and Giant Cell Tumor of the Tendon Sheath > Olecranon Fractures.

[32] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 2Musculoskeletal Trauma Surgery > OLECRANON FRACTURES (ICD-9:813.01).

[34] Outcome after olecranon fracture repair: Does construct type matter?. European Journal of Orthopaedic Surgery & Traumatology. 2015. DOI: 10.1007/s00590-015-1724-0

[36] A novel fragment specific classification of complex olecranon fractures: 3-dimensional model design, radiological validation, and proposed surgical algorithm. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.12.021

[38] Classifications in Brief: Mayo Classification of Olecranon Fractures. Clinical Orthopaedics & Related Research. 2018. DOI: 10.1097/corr.0000000000000614

[42] 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

[47] 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

[49] Surgery for Olecranon Fractures in the Elderly (SOFIE). Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.00655

[50] 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

[51] Randomized Prospective Study of Olecranon Fracture Fixation: Cable Pin System versus Tension Band Wiring. Journal of International Medical Research. 2040. DOI: 10.1177/147323001204000324

[53] Nonoperative Management of Olecranon Fractures in Elderly Patients: A Systematic Review. HAND. 2020. DOI: 10.1177/1558944720944261

[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] Can low-profile double-plate osteosynthesis for olecranon fractures reduce implant removal? A retrospective multicenter study. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.01.091

[60] Plate fixation and tension band wiring after isolated olecranon fracture comparison of outcome and complications. Journal of Orthopaedics. 2020. DOI: 10.1016/j.jor.2019.09.017

[63] 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

[66] The epidemiology of fractures of the proximal ulna. Injury. 2012. DOI: 10.1016/j.injury.2011.10.017