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Olecranon Fracture: Causes, Symptoms & Treatment
An olecranon fracture is a break of the bony tip of the elbow, which is part of the ulna. It is commonly caused by a fall or a direct blow to the elbow.
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An olecranon fracture is a break of the bony tip of the elbow, which is part of the ulna. It is commonly caused by a fall or a direct blow to the elbow.
What is an Olecranon Fracture?
An olecranon fracture is a break of the olecranon – the prominent bony point at the back of the elbow, commonly known as the “elbow tip” or “funny bone prominence.” The olecranon is the posterior part of the ulna, one of the two forearm bones. It forms the hinge joint of the elbow together with the humerus (upper arm bone) and serves as the attachment point for the triceps muscle.
Causes
Olecranon fractures are typically caused by:
- Direct trauma: A fall directly onto the elbow or a direct blow to the elbow tip
- Indirect trauma: A sudden, forceful pull of the triceps muscle during a fall onto an outstretched hand, which avulses the bone (avulsion fracture)
- Sports injuries: Particularly common in contact sports or cycling accidents
- Motor vehicle accidents: Due to impact or ejection
Symptoms
Typical signs and symptoms of an olecranon fracture include:
- Severe pain at the back of the elbow
- Swelling and bruising (haematoma) around the elbow
- Limited range of motion, especially inability to fully extend the arm
- A visible or palpable gap at the elbow tip in displaced fractures
- Weakness: The affected arm often cannot be actively extended against gravity
- Occasional numbness or tingling if the ulnar nerve is affected
Diagnosis
The diagnosis is established through the following investigations:
- Clinical examination: Palpation of the elbow, assessment of range of motion and active extension function
- X-ray: The standard imaging modality to identify the fracture, usually taken in two planes (anteroposterior and lateral views)
- Computed tomography (CT): Used for complex or comminuted fractures to assess fragment displacement in detail
- Magnetic resonance imaging (MRI): Rarely required, but useful when associated ligament or cartilage injuries are suspected
Classification
Olecranon fractures are classified by several systems. The widely used Mayo Classification divides them as follows:
- Type I (non-displaced): The fracture fragments are not or minimally displaced
- Type II (displaced, stable): The fragments are displaced but the elbow joint remains stable
- Type III (displaced, unstable): Displaced fracture with instability of the elbow joint
Treatment
Conservative Treatment
Non-displaced or minimally displaced fractures (Type I) may be managed conservatively:
- Immobilisation of the elbow in a splint or cast for approximately 3–6 weeks
- Pain management with anti-inflammatory medications
- Physiotherapy following immobilisation to restore range of motion and strength
Surgical Treatment
Displaced fractures generally require surgery:
- Tension band wiring: The most common technique – two Kirschner wires and a wire loop fix the fragments and convert triceps tensile forces into compressive forces at the fracture site
- Plate fixation: Used for complex or comminuted fractures, using a plate secured with screws
- Intramedullary screw fixation: Suitable for simple fractures, particularly in elderly patients
- Fragment excision: In elderly patients with severely comminuted fractures, partial removal of the olecranon may be performed
Recovery and Prognosis
Healing typically takes 6–12 weeks. With appropriate treatment and consistent physiotherapy, most patients achieve good to excellent elbow function. Potential complications such as joint stiffness, implant-related discomfort, or delayed bone healing (non-union) are possible but uncommon when the fracture is managed correctly.
References
- Rüedi, T. P., Buckley, R. E., Moran, C. G. (Eds.) – AO Principles of Fracture Management, 2nd Edition. Thieme, Stuttgart (2007).
- Morrey, B. F. – The Elbow and Its Disorders, 4th Edition. Saunders/Elsevier (2009).
- Duckworth, A. D., Clement, N. D., Aitken, S. A. et al. – The Epidemiology of Fractures of the Proximal Ulna. Injury, 43(3):343–346 (2012). PubMed PMID: 21489532.
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