Gãy mỏm khuỷu Thông tin In-depth

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

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

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

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