Orthopaedic Surgeon

Olecranon Fractures

The prominent bone at the tip of the elbow is called the olecranon. It is part of the bone called the ulnar and is almost directly under the skin. Olecranon fractures are among the most common elbow fractures. In older patients most are caused by the pull of the triceps muscle combined with bending over the end of the humerus. In younger patients the mechanism of fracture is usually direct trauma. Direct trauma produces complex fracture patterns, which may be associated with other fractures or dislocations. It is possible for nerve injury to occur at the same time.

Almost all of these fractures require surgery. This is to restore the joint lining surface in the hope of preventing arthritis. Sometimes if the fragments are too small to be fixed the triceps tendon can be stitched directly into bone to allow functional use of the elbow. Most of the time the fractures are either fixed with a combination of straight wires and loop wires which hold the fracture pieces together. More complex fractures will need a metal plate and screws to hold them together. These plates tend to bother people once the fracture has healed because they are directly under the skin and we often lean on our elbows sitting at a table or desk. For this reason the plates are usually removed about a year after the first operation. This is done as a day only procedure and does not cause much ‘down time’ with rapid return to normal function.

Most olecranon fractures heal, and the vast majority of patients recover a functional range of motion. More than half of all patients never fully straighten their elbows again but this does not interfere with their day to day lives. Pain is usually not a problem and often relates to symptomatic hardware. Hardware complications are frequent and further surgery to remove the metal is almost always required.

Failure of the fracture to unite is uncommon (5% of cases) and often does not bother the patient. If it is symptomatic then it is usually fixable with further surgery (with or without supplemental bone grafting). If stiffness develops then usually we will wait for the fracture to unite and deal with the stiffness 6 months later when the hardware is removed

OTHER Elbow Conditions