Patients › Elbow
Fractura del olécrano
Olecranon fractures — patterns, non-operative care, and tension-band or plate fixation.
Qué está sintiendo¶
Una fractura del olécrano es una rotura en la parte posterior del codo, en esa punta ósea que puede sentirse al tacto. Generalmente ocurre tras una caída sobre el codo o un golpe directo. En ocasiones, un estiramiento brusco y fuerte del brazo contra resistencia hace que un fragmento óseo se desprenda de la punta.
De inmediato, sentirá dolor en la parte posterior del codo. Esa zona suele hincharse considerablemente, y puede acumularse líquido bajo la piel en el punto de la fractura. Dado que ese hueso se encuentra justo debajo de la piel, es posible sentir la propia fractura a través de la hinchazón. Su brazo puede presentar hematomas, y probablemente le resultará difícil doblar o estirar el codo.
Si la fractura desplaza algún fragmento óseo, resultará difícil o imposible estirar el brazo contra la gravedad. El músculo situado en la parte posterior del brazo normalmente se fija a esa punta ósea; cuando ese punto de anclaje se separa, el músculo ya no puede actuar correctamente. Es posible notar una separación o un cambio en la forma de la parte posterior del codo.
En los primeros días, el dolor suele ser más intenso al mover el brazo y por la noche. Acciones sencillas como alcanzar una taza, vestirse o apoyarse en el codo resultan dolorosas. Dormir con ese brazo debajo del cuerpo resulta incómodo.
Durante las primeras semanas, el dolor disminuye gradualmente a medida que el hueso comienza a soldarse. Es normal experimentar cierta rigidez, y es posible que no logre estirar completamente el codo incluso después de la curación. La mayoría de las fracturas sanan sin complicaciones.
Su cirujano examinará todo el brazo, desde el hombro hasta la mano, ya que el codo queda justo bajo la piel y esta también puede resultar lesionada. Las radiografías tomadas desde dos ángulos suelen mostrar claramente la fractura. Si la fractura es compleja, una tomografía computarizada, que proporciona imágenes más detalladas, puede revelar mejor la disposición de los fragmentos; sin embargo, no es necesaria en la mayoría de los casos.
Si el codo también sufrió una luxación además de la fractura, se toman nuevas radiografías una vez que se ha vuelto a colocar en su posición normal.
¿Qué ocurre realmente?¶
La punta del codo está formada por un único trozo de hueso que funciona como una especie de tapa bisagra. Este hueso rodea un extremo del hueso del brazo y se desliza dentro de un surco allí presente al doblar o estirar el codo. Esa punta ósea también sirve como punto de anclaje para el tendón del músculo situado en la parte posterior del brazo, el que se encarga de estirar el codo.
Dado que este hueso se encuentra justo debajo de la piel y no tiene mucho tejido que lo proteja, un golpe o una caída pueden fracturarlo fácilmente. Cuando se rompe, el tendón sigue tirando del fragmento óseo. Esa fuerza arrastra el fragmento hacia arriba y fuera de su posición, creando un hueco en la superficie articular lisa. Al quedar suelto el punto de anclaje, el músculo ya no puede estirar el codo contra la gravedad. Es como una bisagra de puerta de la que se hubiera roto un trozo del mecanismo: la bisagra puede moverse, pero el mecanismo ya no tiene nada sólido a lo que agarrarse.
La fractura en sí sana de la misma manera que cualquier otra fractura ósea: los dos bordes se unen mediante nuevo hueso a lo largo de varias semanas. Si el fragmento se ha desplazado de su posición original, es necesario mantenerlo inmóvil y cerca de su lugar para que esa unión ocurra; a veces, para ello se requieren placas, alambres o puntos de sutura resistentes.
No todas las fracturas son iguales. Algunas son simples grietas pero el hueso sigue alineado; otras se desplazan de su posición; otras afectan la estabilidad misma de la articulación del codo. Las fracturas que permanecen alineadas suelen curarse sin intervención quirúrgica, mientras que aquellas que están desplazadas, compuestas por varios fragmentos o que generan inestabilidad articular, normalmente requieren cirugía para recolocarlos y fijarlos.
La mayoría de estas fracturas ocurren de forma espontánea, pero la misma caída puede lesionar otras partes del brazo, y el hueso fracturado puede abrir un corte en la piel del codo. Su cirujano evaluará ambas posibilidades.
¿Qué podemos hacer al respecto?¶
El Dr. Kieran Hirpara, cirujano de extremidades superiores en el Mater Private Hospital Rockhampton, adapta el tratamiento a la lesión específica de cada paciente. Por lo general, los pacientes son derivados a nuestra clínica por su médico de cabecera; si un fisioterapeuta le ha recomendado que nos consulte, igualmente necesitará una derivación de su médico de cabecera para poder acceder al reembolso de Medicare. En esa primera consulta, tomamos el historial clínico, examinamos el brazo y, cuando es necesario, utilizamos radiografías o tomografías computarizadas para determinar el patrón de la fractura.
Algunas fracturas permanecen alineadas o apenas se desplazan; además, algunas personas tienen otros problemas de salud que hacen que la cirugía no sea una opción adecuada. En esos casos, podríamos sugerir un tratamiento sin intervención quirúrgica. Generalmente esto implica el uso de un cabestrillo, férula o escayola para mantener el codo inmóvil mientras el hueso se repara, además de realizar radiografías de control para asegurarnos de que no haya desplazamientos. Una vez que la fractura está lista, se recupera el movimiento gradualmente mediante fisioterapia. Este enfoque resulta especialmente adecuado para personas mayores y menos activas; incluso puede ser válido cuando la fractura está ligeramente desplazada.
Otras fracturas requieren cirugía desde el principio. Si el fragmento óseo se ha desplazado considerablemente, si la articulación del codo es inestable o si la fractura está compuesta por varios fragmentos, la operación permite volver a colocarlos y fijarlos para que el hueso se repare en la posición correcta. La reparación debe ser lo suficientemente sólida para permitir el inicio temprano de los movimientos, lo cual ayuda a evitar la rigidez del codo. La mayoría de los pacientes sometidos a cirugía para este tipo de fracturas tienen buenos resultados; no obstante, es frecuente una pérdida leve de la capacidad de estirar completamente el brazo, y a veces es necesario extraer los implantes metálicos posteriormente por causar molestias. La decisión se toma de forma conjunta: en el caso de ciertas fracturas en personas mayores, ambos enfoques pueden ser válidos, y la elección depende de cuánta molestia esté dispuesto a soportar y del resultado final que desee para su codo.
Independientemente del camino que elija, las primeras semanas son similares en ambos casos. El alivio del dolor le mantendrá cómodo mientras disminuye la hinchazón. Deberá proteger el brazo mientras el hueso se repara, respetando los límites que le indiquemos. La fisioterapia comenzará en el momento adecuado según su lesión, restaurando el movimiento de forma gradual. A lo largo del proceso, le haremos seguimiento para comprobar que la fractura se esté curando correctamente.
Qué esperar¶
La mayoría de estas fracturas sanan bien. El hueso se une a lo largo de varias semanas, y el dolor disminuye con el tiempo. La mayor parte de los pacientes terminan con un codo funcional; sin embargo, es común una ligera pérdida de la capacidad de estirarlo por completo, algo que generalmente no supone problemas en la vida cotidiana.
Si su fractura se trata sin cirugía, deberá usar un cabestrillo, férula o escayola mientras el hueso se une, y acudir a revisiones con radiografías para asegurarnos de que no haya desplazamientos. En personas mayores que siguen este tratamiento, la funcionalidad al cabo de seis meses suele ser buena, y la fractura puede sanar sin complicaciones. El principal riesgo es que los fragmentos óseos se muevan antes de unirse, por lo que los vigilamos de cerca.
En caso de cirugía, los fragmentos se fijan firmemente para que el hueso se una en la posición correcta; el uso de placas garantiza una curación fiable. La mayoría de los pacientes recuperan la movilidad y pueden realizar sus tareas diarias en cuestión de semanas; la fisioterapia contribuye a una mayor recuperidad en los meses siguientes. A largo plazo, el 96 % de quienes recibieron este tratamiento para fracturas desplazadas refieren una función del codo buena o muy buena; estos resultados se han seguido hasta 25 años después de la lesión.
La recuperación no siempre es sencilla. El problema más frecuente tras la cirugía es no recuperar la capacidad de estirar el codo por completo; esto ocurre en el 39 % de los pacientes con placas. El material metálico queda justo debajo de la piel y, en ocasiones, genera molestias suficientes como para requerir su extracción posteriormente. Si no se mantiene la movilidad del codo, puede aparecer rigidez; además, años después de la lesión es posible desarrollar artritis, sobre todo cuando la fractura implicaba varios fragmentos.
En el caso de los niños, las fracturas tratadas sin cirugía requieren un seguimiento radiográfico riguroso, pues los fragmentos pueden desplazarse tras iniciar el tratamiento. Una fractura en un niño suele formar parte de una lesión más compleja alrededor del codo, por lo que se examina todo el brazo con detenimiento.
Las personas mayores enfrentan riesgos adicionales más allá del propio codo. Las fracturas de este tipo en ancianos conllevan tasas de mortalidad en el primer año superiores a lo esperado; por ello evaluamos cuidadosamente la cirugía frente a otros problemas de salud antes de recomendar cualquier tratamiento.
¿Cuándo consultar a un médico?¶
Busque atención urgente si su codo parece deformado, si la piel está rota, si presenta entumecimiento u hormigueo, o si no puede usar el brazo en absoluto. En la mayoría de los demás casos de fracturas, comience por consultar a su médico de cabecera, quien podrá ordenar radiografías y derivarlo a un especialista si fuera necesario. Una vez iniciado el tratamiento, vigile cómo evoluciona la situación semana tras semana. Consulte a su médico de cabecera o solicite una evaluación especializada si el dolor no disminuye, o si la hinchazón, la movilidad o la capacidad para realizar actividades cotidianas no muestran mejoría de una semana a la siguiente mientras el hueso sana. Confíe en lo que usted percibe: un progreso lento es normal, pero la ausencia total de progreso merece ser evaluada.
En mayor profundidad¶
Esta sección profundiza más de lo necesario para que usted tome decisiones sobre su propio tratamiento. La fractura del olécrano merece una lectura adicional debido a un hallazgo que invierte la lógica habitual en la cirugía de fracturas: en pacientes de edad avanzada, una fractura desplazada del olécrano puede dejarse sin fijar y, aun así, el codo funciona correctamente.
La fractura desplazada que no requiere corrección¶
Una fractura en el olécrano separa el tríceps del antebrazo; por ello, la lógica habitual indica que debe reinsertarse para que el codo pueda estirarse contra resistencia. Sin embargo, en pacientes mayores de 70 años esta lógica no se aplica. Una revisión sistemática demostró que las fracturas desplazadas del olécrano en este grupo pueden tratarse eficazmente sin cirugía, logrando alta satisfacción y un rango de movimiento funcional [1].
Lo que se “paga” como costo es medible: una pérdida de extensión, la imposibilidad de estirar completamente el codo y una disminución de la fuerza en dicha extensión. En cambio, lo que se evita es una herida sobre un hueso subcutáneo en piel delgada y frágil, así como el uso de material metálico bajo dicha piel. Dado que la presencia de implantes es la causa más frecuente de una segunda intervención tras la fijación del olécrano, evitarlos elimina por completo la complicación más habitual.
Para una persona mayor cuyo brazo se utiliza para tareas cotidianas y no para empujes fuertes, un codo que no alcanza los últimos grados de extensión supone una molestia menor que cualquier complicación derivada de una herida. Para un paciente más joven o con mayores exigencias funcionales, no es así; por eso este hallazgo es específico de la edad y no de carácter general.
En los casos en que se emplea la fijación, la elección del implante varía¶
Para el patrón común de fracturas desplazadas pero sencillas, compiten dos tipos de implantes: una estructura de banda de tensión hecha con alambres y una placa. En 827 pacientes con fracturas de tipo II según la clasificación de Mayo, la fijación con placa demostró mayor eficacia y seguridad que el uso de bandas de tensión con alambres; los autores señalan, no obstante, que se incluyeron pocos estudios y que aún se requieren ensayos aleatorizados de mayor calidad [2]. Una revisión de 2025 realizada con 472 pacientes, que compara técnicas modernas de fijación con el método tradicional de bandas de tensión, llega a la misma conclusión [3].
Este es uno de los pocos casos en este sitio donde la comparación entre técnicas arroja resultados claros en lugar de dejar la cuestión en el aire. No obstante, conviene tomar estos hallazgos con cautela, dado que los propios autores advierten sobre la limitada base de evidencia disponible.
Se desarrolla artritis, pero en la mayoría de los casos no supone un problema¶
Los hallazgos imagenológicos a largo plazo pueden resultar alarmantes si se comunican sin contexto. Tras fracturas aisladas del olécrano, la incidencia media de artrosis postraumática fue del 19 % con un seguimiento medio de 41 meses, y los resultados finales reportados por los pacientes variaron entre buenos y excelentes, independientemente del tipo de fractura o de la presencia de artritis [4].
Ambas partes de esa oración son esenciales. La aparición de artritis en radiografías de seguimiento tras esta lesión es frecuente; sin embargo, en este período de tiempo, dicha artritis apenas influye en la percepción que los pacientes tienen de la funcionalidad de su codo. Un hallazgo radiológico no equivale automáticamente a un problema clínico, y por sí solo no debería ser motivo para iniciar intervenciones adicionales.
Referencias¶
[1] Alvara CA, Biedron G, Dunn JC. Tratamiento no quirúrgico de las fracturas del olécrano en pacientes ancianos: una revisión sistemática. Hand (N Y). 2020;17(4):734-9. https://doi.org/10.1177/1558944720944261
[2] Jia Y, Liu A, Guo T, Chen J, Yu W, Zhai J. Eficacia y seguridad del alambre de banda de tensión frente a la placa en fracturas del olécrano de tipo Mayo II: una revisión sistemática y metaanálisis. J Orthop Surg Res. 2022;17(1). https://doi.org/10.1186/s13018-022-03262-7
[3] Wang C, Li C. Técnicas modernas de fijación frente al método tradicional de alambre de banda de tensión para fracturas del olécrano: una revisión sistemática y metaanálisis. J Orthop Surg Res. 2025;20(1). https://doi.org/10.1186/s13018-025-06061-y
[4] Wiersma JP, de Klerk HH, Priester-Vink S, Doornberg JN, Bhasyam AR, van den Bekerom MP. Incidencia de artrosis postraumática en fracturas del olécrano y el papel del tipo de fractura: una revisión sistemática. J Shoulder Elbow Surg. 2026. https://doi.org/10.1016/j.jse.2026.02.024
Evidence & references
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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