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Olecranon fracture



  • Olecranon fractures account for approximately 10% of upper extremity fractures1
  • There are 3 types of fractures
    • Type I
      • Nondisplaced
      • Accounts for 5-12% of olecranon fractures
    • Type II
      • Displaced at least 3mm, but collateral ligaments may still be intact
      • Most common 80-85% of olecranon fractures
    • Type III
      • Displaced and the ulnohumeral joint is unstable
      • This injury is a fracture-dislocation, collateral ligaments may be incompetent causing instability2
      • Accounts for 6% of olecranon fractures


  • Common injury in adults, susceptible to direct blow3


  • Acute and traumatic event such as fall on elbow
  • Avulsion fractures may also occur from eccentric contraction of the triceps tendon

Risk factors

  • 50 years of age or older (mean age is 57)
  • Males more likely to sustain an injury at a younger age


  • Posttraumatic arthritis occurs in approximately 20% of cases and persistent malreduction >2mm of the articular surface is associated with this outcome4
  • In fractures with significant comminution, inadvertent malreduction by narrowing the greater sigmoid notch may further predispose the patient to arthritis5
  • A displaced fracture may interfere with the extensor mechanism resulting in loss of active elbow extension
    • The pull of the triceps is the key deforming cause
  • The ulnar nerve is at risk of involvement due to its position


  • If displaced there may be a palpable gap
  • Passive flexion and extension may be limited (capsular pattern)
  • Resisted extension is painful and weak
  • Tenderness


  • In general
    • Patients usually have a good functional outcome after treatment6
      • Approximately 10-15 degree loss of extension may occur, although this is usually not clinically significant
      • Long-term follow-up ranging 15-25 years reported good or excellent functional outcome in 96% of patients7
      • Fractures have a high rate of healing with a nonunion rate of approximately 1%8


  • Type I
    • Immobilization – posterior splint in slight extension 45-90 degrees of flexion
      • Followed by progressive active range of motion exercises with avoidance of active extension
    • Type II and III
      • Generally require surgery
      • Type II may be treated non-operative. They may lose full elbow extension due to disruption of the extensor mechanism but in some patients this is thought to be preferential to the risk of surgery