Olecranon Fracture

Fracture of the Ulna at the Level of the Elbow Joint

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An olecranon fracture is an injury to one of the bones of the elbow. The olecranon is the prominent bone that forms the point of the elbow. The bone is actually the end of the ulna, one of the two forearm bones, and it is the attachment of the powerful triceps muscle of the arm. The triceps is the muscle that straightens the elbow, and olecranon fractures can impair an individual's ability to straighten the elbow joint.

Olecranon fractures can occur by either falling directly on the back of the elbow, or by the triceps muscle pulling off a fragment of bone from the elbow (a so-called avulsion fracture). Stress fractures are also a possible mechanism of injury to the olecranon, commonly seen in athletes such as baseball pitchers.

Signs of Olecranon Fracture

Patients who have a trauma such as a fall or car accident, and have pain in the elbow, or difficulty moving the elbow, should be evaluated for an olecranon fracture.  Signs of an olecranon fracture include:

  • Pain behind the elbow
  • Difficulty bending the elbow joint
  • Swelling and bruising of the elbow
  • Deformity of the bone behind the elbow

Olecranon fractures are often suspected based on physical examination findings, although a definitive diagnosis is typically made by x-ray examination. X-rays are usually sufficient to both diagnose and determine treatment of the problem.

In some more subtle injuries, such as stress fractures, an MRI can be helpful in making the diagnosis.

Treatment of an Olecranon Fracture

Treatment of an olecranon fracture depends on the amount of displacement of the fracture fragments and the function of the triceps muscle. If the fracture is non-displaced, or minimally displaced, and the triceps muscle is able to extend the elbow, then surgery may not be necessary.

In these cases, protection from activity (splint or sling) and time will generally heal the fracture. Otherwise, surgical treatment of olecranon fractures is the usual treatment.

Surgery is the proper treatment when the bone fragments are out of position, or if the triceps muscle is not functioning because of the injury. There are several ways to surgically repair an olecranon fracture. An incision is made over the back of the elbow joint, and the bone fragments are repositioned into the proper location. Either pins, wires, screws, or plates may be used to secure the bone fragments in the proper position.

Surgery is also necessary when the injury is an open fracture. An open fracture occurs when the bone penetrates the skin, causing a pathway for infection to get into the area of the healing bone. Open fractures almost always require surgery in order to lower the chance of infection.

After surgery, patients are usually immobilized for a brief period, but the goal is to begin elbow motion as soon as possible. Usually gentle motion is started within the first weeks following surgery. The amount of motion allowed depends on the strength of the fracture repair and the surrounding bone. Total healing time of an olecranon fracture is about 10-12 weeks.

Complications of Olecranon Fractures

The most common complication following surgery for an olecranon fracture is that often the metal pins, wires, and/or screws must be removed. There is little soft-tissue padding over the back of the elbow, and these metal implants can be bothersome--especially when leaning on your elbow. In these situations, the metal will be removed, usually at least 6 months after surgery.

Patients also usually have slightly decreased motion of the injured elbow after surgery, although this often is not noticeable. If elbow motion is initiated soon after surgery, then most patients are able to recover most of their motion, only noticing a slight difference when comparing motion with their unaffected elbow.

Other possible complications include:

  • Infection
  • Non healing fractures
  • Failure of the fixation to hold the fragments in place
  • Elbow pain

Healing of the injury typically takes 10-12 weeks, although more severe injuries can take longer to regain full mobility and normal strength. In individuals who are more athletically active, physical therapy can help to regain full strength and mobility to the elbow joint.


Elbow (Olecranon) Fractures, American Academy of Orthopaedic Surgeons, October, 2007

Rouleau DM, Sandman E, van Riet R, Galatz LM. "Management of fractures of the proximal ulna" J Am Acad Orthop Surg. 2013 Mar;21(3):149-60.

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