Skip to content

Clinicians › Elbow

Olecranon Fracture Fixation (ORIF)

48 citationsUpdated Aug 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Olecranon fractures are typically managed surgically to restore the extensor mechanism, with operative techniques including Kirschner wire tension band combined with anatomical locking plate, suture anchor fixation, and low-profile double-plate osteosynthesis [1, 3, 4]. For Mayo type II fractures, plate fixation demonstrates better efficacy and safety compared to tension band wiring [23], although some data indicate no significant differences in clinical or patient-rated outcome measures between these two methods [10]. Modern fixation techniques may offer superior functional outcomes, faster healing, and fewer complications than traditional tension band wiring [15]. Regardless of the specific surgical method, fracture type, or patient gender, no significant differences in functional outcomes or secondary operations are observed [9].

Nonoperative management remains a viable option for specific populations. Displaced fractures in patients older than 70 years may be effectively managed nonoperatively to produce high satisfaction and functional range of motion [17]. Data on managing these fractures nonoperatively in patients over 75 years old offers valuable information for developing personalized treatment plans, though it does not definitively settle the debate on this approach [5]. For displaced olecranon fractures, the timing of fixation does not significantly increase the rate of early complications or reoperation [2]. However, surgical treatment is generally associated with a high rate of complications [9].

Conservative management yields favorable results in select cases. A majority of olecranon fractures heal uneventfully with good or excellent results, with a small loss of motion to be expected [6]. In pediatric cases, nonsurgically treated minimally displaced olecranon fractures require close radiographic follow-up due to the risk of further displacement [7].

Anatomy & Pathophysiology

Osseous and Articular Considerations

The guiding principle in surgical techniques for olecranon fractures is to restore a congruent humeroulnar joint and allow restoration of upper extremity function [48]. Fixation of olecranon fractures must be secure enough to permit early motion to avoid significant stiffness of the elbow joint [12]. Individuals with elbow degenerative changes had no inferior subjective elbow function compared to those with normal radiographs, except for those with joint space reduction [36].

Ligamentous and Soft Tissue Dynamics

The proposed fragment-specific classification system for complex olecranon fractures is anatomically based and considers deforming forces from ligaments and tendons [28]. Overhead elbow extension in the setting of a displaced olecranon fracture may be maintained if there is any continuity of the extensor mechanism with the ulnar shaft [54]. The medial forearm fascia and lateral forearm fascia contribute to overhead elbow extension in displaced olecranon fractures [54].

Complex Instability and Surgical Exposure

Trans-olecranon fracture posterior dislocation is a rare injury with unique characteristics involving complex elbow instability [44]. Proximal ulnar osteotomy improves the visualization of the distal humeral articular surface compared with olecranon osteotomy [50].

Classification

Multiple classification systems for olecranon fractures exist, including AO, Mayo, Schatzker, and Colton [43]. None of these systems are widely accepted or provide direct and reliable advice on operative strategies [43].

Mayo: This system categorizes olecranon fractures into Type I (non-displaced), Type II (displaced stable), and Type III (unstable with dislocation) [31]. It subdivides each type into A (non-comminuted) and B (comminuted) [31]. Although designed to simplify categorization, the Mayo classification has poor reproducibility [40].

AO/OTA: The AO classification subsumes olecranon fractures to proximal forearm injuries [43].

Schatzker: This classification divides fractures into groups based on the quantity of fragments and fracture lines [43].

Colton: Similar to Schatzker, the Colton classification divides fractures into groups based on the quantity of fragments and fracture lines [43].

Gächter & Stutz: A novel fragment-specific classification system for complex olecranon fractures is anatomically based and considers deforming forces from ligaments and tendons [28].

Other Considerations: 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 [43]. Isolated olecranon fractures occur after low-energy trauma, especially in older women over 65 years of age [20]. Men show a higher proportion of high-energy trauma than women in both age groups regarding olecranon fractures [20]. The fracture mechanism in most cases is a direct impact to the posterior aspect in the range of 60° to 110° flexion [43]. Due to tension of the triceps brachii muscle, most olecranon fractures are dislocated and not suitable for conservative treatment [43]. Nonoperative treatment is common in uncomplicated olecranon fractures [20]. Aggregate data support the non-operative treatment of isolated undisplaced olecranon fractures with good results [8]. Aggregate data support the operative treatment of pediatric olecranon fractures displaced ≥4 mm [8]. Nonoperative treatment was performed in 21% of patients aged 65 years or older in a nationwide study [20]. Tension band wiring was used for most simple central olecranon fractures in a nationwide study [20]. Plate fixation was used in almost half of the operatively treated fractures classified as unstable comminuted central and distal olecranon fractures in a nationwide study [20].

Clinical Presentation

Olecranon fractures typically present in adults with an average age of 56.0 years (SD, 19.4 years), with a demographic profile essentially similar to that of patients with distal radius fractures [13, 47]. In population-based cohorts, females comprise 53.9% and males 46.1% of cases [13]. The majority of these fractures heal uneventfully with good to excellent results, though a small loss of motion is expected [6].

Fracture Morphology: In adult ORIF populations, 52.6% of fractures are comminuted and 47.4% are non-comminuted [13]. Classification distribution is predominantly Mayo Type II (78.8%), followed by Type III (10.9%) and Type I (10.3%) [13].

Associated Injuries: Most patients present with isolated injuries; 82.9% have no other fracture present, while 17.1% have an associated fracture [13]. Dislocations are uncommon: 89.4% have no dislocation, 10.3% have radiocapitellar dislocation, and 0.3% have ulnohumeral dislocation [13]. The Monteggia fracture pattern is rare, present in only 7.2% of cases (92.8% do not have this pattern) [13].

Complications and Outcomes: ORIF demonstrates low short-term complication rates [32]. However, smoking and ascites are specific comorbidities associated with an increased risk of short-term complications following ORIF [32]. Patients undergoing revisions beyond implant removal experience poorer functional outcomes [9].

Pediatric Considerations: In children, close radiographic follow-up is recommended for nonsurgically treated olecranon fractures due to the risk of further displacement after initial nonsurgical treatment [7].

Investigations

Plain radiography: Isolated olecranon fractures typically result from low-energy trauma, predominantly affecting older women (>65 years) [20]. The median patient age is 66 years, with 65% being female [20]. Fracture morphology distribution includes 12% proximal avulsion, 42% simple central, 29% comminuted central, and 16% distal [20]. In a nationwide study, 21% of patients aged ≥65 years received nonoperative treatment [20].

MRI: No specific MRI findings or indications are provided in the current evidence base.

CT: No specific CT findings or indications are provided in the current evidence base.

Bone scan: No specific bone scan findings or indications are provided in the current evidence base.

Tomosynthesis: No specific tomosynthesis findings or indications are provided in the current evidence base.

Aspiration: No aspiration protocols or findings are provided in the current evidence base.

Laboratory: No laboratory markers or indications are provided in the current evidence base.

Other Considerations: Pediatric Management: Nonoperative treatment yields good results for isolated undisplaced olecranon fractures in pediatric patients [8]. Operative treatment is indicated for pediatric fractures displaced ≥4 mm [8].

Associated Injuries: Ipsilateral olecranon fractures associated with radial neck fractures are not as rare as previously reported [62].

Surgical Planning: Fixation must be secure enough to permit early motion to avoid significant elbow stiffness [12]. No single technique manages all olecranon fractures [14]. Tension band wiring is used for most simple central olecranon fractures [20]. Plate fixation is utilized in almost half of operatively treated unstable comminuted central and distal olecranon fractures [20].

Outcome Assessment: The Subjective Elbow Value (SEV) correlates highly with the most commonly used scoring systems for elbow injury outcome evaluation [22].

Clinical Trial Data: The SOFIE trial randomized 64 patients with displaced olecranon fractures: 29 to operative and 35 to nonoperative groups [19]. Two patients from each group were lost to follow-up and excluded from the primary analysis [19].

Treatment

Non-Operative Management

Evidence does not definitively settle whether to manage olecranon fractures nonoperatively in patients over 75, but it offers data to develop personalized treatment plans tailored to each patient's needs [5]. Displaced olecranon fractures in elderly and medically unwell patients treated nonoperatively can result in reasonable range of motion, minimal pain, and maintenance of extension against gravity [53]. Aggregate data support the non-operative treatment of isolated undisplaced olecranon fractures with good results in pediatric patients [8].

Operative Management

Indications: Surgical treatment of olecranon fractures is associated with a high rate of complications, and patients undergoing revisions beyond implant removal had poorer functional outcomes [9]. There were no significant differences in functional outcomes or secondary operations with respect to fracture type, gender, or surgical method in the context of complications after open reduction and fixation [9].

Surgical Approach / Technique: A midline posterior incision with a slight lateral bent on the olecranon tip is used to avoid the weight-bearing zone during olecranon osteotomy approaches [67]. Anterior transposition of the ulnar nerve is performed in all cases during olecranon osteotomy or paratricipital approaches for complex intra-articular distal humerus fractures [67]. Chevron shape osteotomy of the ulna with apex distally at approximately 2 cm from the olecranon tip is used to expose the fracture, with the osteotomy site fixed with K wires stabilized with an 18-gauge wire in accordance with tension band wire principles [67].

Implant Selection: Low-profile double-plate osteosynthesis is a safe and effective alternative treatment for olecranon fractures, yielding excellent subjective and objective clinical outcome measures [4]. Fixation of simple olecranon fractures with an intramedullary screw is a safe and easy method in young patients, leading to good functional and radiological results [16]. Plate fixation has better efficacy and safety than tension band wiring for Mayo II olecranon fractures [23]. The suture tension band technique is a viable option for managing simple olecranon fractures or fractures with minimal comminution, yielding excellent clinical and radiographic outcomes while avoiding hardware-related complications [29]. Internal fixation by cable pin system (CPS) is an effective method for olecranon fracture associated with shorter healing time, fewer complications, and better function than tension band wiring (TBW) [30]. Transosseous suture with high strength thread is a valid alternative for treating Mayo IIA olecranon fractures in adult patients, decreasing re-operation rates for implant removal [52]. A novel technique using suture tension band fixation with eyelet wires for simple olecranon fractures is hypothesized to provide satisfactory outcomes regarding pain, functional scores, and radiographic union [60]. Surgical treatment with plate fixation and bone grafting in a patient with a displaced olecranon fracture through a persistent physis resulted in bony union, full range of motion, and return to sports without complications at 2.5 years [21].

Pain Management: The use of wide-awake local anesthesia no tourniquet (WALANT) for olecranon fracture fixation is a simple, safe, low-cost, and reproducible technique that obviates the need for general anesthesia or tourniquets [45].

Setting of Care: The use of wide-awake local anesthesia no tourniquet (WALANT) for olecranon fracture fixation is a simple, safe, low-cost, and reproducible technique that obviates the need for general anesthesia or tourniquets [45].

Revision: In a cohort of patients aged 75-93 years with displaced olecranon fractures, complications developed in 40% of patients, including construct disassembly, infection, non-union, bone failure due to proximal fragmentation, and incomplete nerve injury [31]. Of 21 fractures treated by tension-band wiring in patients aged 75+, 33% were followed by complications and 8 required hardware removal [31]. Of 7 hook-plate fixations in patients aged 75+, 71% were followed by complications and 43% required hardware removal [31]. In the same elderly cohort, 37% of patients required revision surgery [31]. Locked plating of geriatric olecranon fractures with early mobilization leads to low fixation failure in patients over the age of 75 [11].

Complications

Hardware complications: Precontoured plate fixation of the olecranon is associated with hardware complications and reoperations [13].

Post-traumatic osteoarthritis: The incidence of post-traumatic osteoarthritis following isolated olecranon fractures has a median incidence of 19% at a median follow-up of 41 months [61].

Mortality: Olecranon fractures in the elderly have higher than expected 1 year mortality rates [68].

Other Considerations: Complication rates, including deep infection and nonunion, are high in transolecranon distal humerus fractures, with frequent long-term functional limitations [69].

Recovery

Light activity (weeks): Evidence does not provide specific week ranges for light activity or desk work return. Nonoperative management data in patients over 75 informs personalized plans but does not definitively settle the debate on this approach [5]. For pediatric patients, aggregate data support non-operative treatment of isolated undisplaced fractures with good results [8], though close radiographic follow-up is recommended due to the risk of further displacement after initial nonsurgical treatment [7].

Full activity (months): Professional baseball players undergo return to sport at a rate of 67.5% following olecranon ORIF [63]. This return rate is no different from natural attrition among matched controls [63].

Complete recovery / outcome plateau (months): Primary osteosynthesis successfully restored structural stability and achieved union at 6 months in a patient with bilateral olecranon fractures as the first presentation of sarcoidosis [35]. Patients undergoing revisions beyond implant removal for olecranon fractures had poorer functional outcomes [9]. No significant differences in functional outcomes or secondary operations were found with respect to fracture type, gender, or surgical method [9].

Rehabilitation protocol: Specific rehabilitation protocols, immobilisation durations, or weight-bearing progressions are not detailed in the provided evidence.

Functional milestones: Low-profile double-plate osteosynthesis for treating olecranon fractures resulted in good clinical outcomes [33]. Ding’s screw and tension band wiring (DSTBW) technology provides stable fixation for olecranon fractures, reducing the risk of internal fixation migration and failure [55].

Other Considerations: No specific functional milestones or PROM trajectories are provided in the evidence base.

Key Evidence

  • [L3] Both operative procedures effectively treat Mayo type II olecranon fractures. [1] (10.1186/s12891-025-08843-1)
  • [L3] The timing of fixation of displaced olecranon fractures does not significantly increase the rate of early complications or reoperation. [2] (10.1016/j.jhsg.2023.09.002)
  • [L4] Suture anchor fixation of displaced olecranon fractures resulted in excellent midterm functional outcomes. [3] (10.5397/cise.2023.00528)
  • [L3] Low-profile double-plate osteosynthesis is a safe and effective alternative treatment of olecranon fractures with excellent subjective and objective clinical outcome measures. [4] (10.1016/j.otsr.2019.08.019)
  • [L2] While they did not definitively settle the debate about whether we should manage olecranon fractures nonoperatively in patients over 75, they did offer valuable data that surgeons and patients can use to develop personalized treatment plans tailored to each patient's needs. [5] (10.2106/jbjs.24.01097)
  • [L4] A majority of olecranon fractures heal uneventfully with good/excellent results with a small loss of motion to be expected. [6] (10.1016/j.hcl.2015.07.003)
  • [L4] Close radiographic follow-up for nonsurgically treated olecranon fractures is recommended. [7] (10.5435/jaaos-d-25-00821)
  • [L4] Aggregate data support the non-operative treatment of isolated undisplaced olecranon fractures with good results, and support the operative treatment of fractures displaced ≥4 mm. [8] (10.1302/2058-5241.5.190082)
  • [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. [9] (10.1016/j.xrrt.2025.08.004)
  • [L1] No differences were found in clinical or patient-rated outcome measures between the two most frequent fixation methods (tension band wiring and plate fixation) of displaced olecranon fractures. [10] (10.1177/1457496919893599)
  • [L4] Locked plating of geriatric olecranon fractures with early mobilization leads to low fixation failure. [11] (10.1016/j.jse.2020.01.027)
  • [L5] Fixation must be secure enough to permit early motion to avoid significant stiffness of the elbow joint. [12] (10.5435/00124635-200007000-00007)
  • [L4] [13] (10.1016/j.jse.2022.04.006)
  • [Paper] No one technique is suitable for the management of all olecranon fractures. [14] (10.1016/j.injury.2008.12.013)
  • [L1] Modern fixation techniques may offer superior functional outcomes, faster healing, and fewer complications than traditional tension band wiring for olecranon fractures. [15] (10.1186/s13018-025-06061-y)
  • [L4] Fixation of simple olecranon fractures with an intramedullary screw is a safe and easy fixation method in young patients, leading to good functional and radiological results. [16] (10.1007/s00068-019-01114-4)
  • [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. [17] (10.1177/1558944720944261)
  • [L1] [19] (10.2106/jbjs.24.00655)
  • [L4] [20] (10.1007/s00068-021-01765-2)
  • [Case_report] Surgical treatment with plate fixation and bone grafting in a patient with a displaced olecranon fracture through a persistent physis resulted in bony union, full range of motion, and return to sports without complications at 2.5 years. [21] (10.1177/2325967119881647)
  • [L4] The SEV shows a high correlation to the most commonly used scoring systems for outcome evaluation after elbow injury. [22] (10.1055/a-0946-2649)
  • [L1] Plate has better efficacy and safety for Mayo II olecranon fractures. [23] (10.1186/s13018-022-03262-7)
  • [L4] This proposed classification system is anatomically based and considers the deforming forces from ligaments and tendons. [28] (10.1016/j.jse.2023.12.021)
  • [L4] The suture tension band technique is a viable option for managing simple olecranon fractures or fractures with minimal comminution, yielding excellent clinical and radiographic outcomes while avoiding hardware-related complications. [29] (10.1016/j.jseint.2025.04.032)
  • [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. [30] (10.1177/147323001204000324)
  • [L4] [31] (10.1016/j.otsr.2021.103089)
  • [L4] ORIF for olecranon fractures demonstrates low short-term complication rates; however, specific comorbidities such as smoking and ascites were associated with increased risk. [32] (10.1016/j.jseint.2025.06.017)
  • [L3] Low-profile double-plate osteosynthesis for treating olecranon fractures resulted in good clinical outcomes. [33] (10.1016/j.jse.2020.01.091)
  • [Case_report] Primary osteosynthesis successfully restored structural stability and achieved union at 6 months in a patient with bilateral olecranon fractures as the first presentation of sarcoidosis, contrasting with previous reports of nonunion in known sarcoidosis cases. [35] (10.1016/j.jse.2007.06.016)
  • [L3] Individuals with elbow degenerative changes had no inferior subjective elbow function compared to those with normal radiographs, except for those with joint space reduction. [36] (10.1007/s00402-020-03453-z)
  • [L5] The Mayo classification was designed to simplify categorization of olecranon fractures but does not achieve this goal due to poor reproducibility. [40] (10.1097/corr.0000000000000614)
  • [L4] [43] (10.1016/j.jor.2019.09.017)
  • [L4] Trans-olecranon fracture posterior dislocation is a rare injury with unique characteristics involving complex elbow instability. [44] (10.1186/s13018-023-03563-5)
  • [L4] The use of wide-awake local anesthesia no tourniquet for olecranon fracture fixation is a simple, safe, low-cost, and reproducible technique that obviates the need for general anesthesia or tourniquets. [45] (10.1016/j.jhsg.2022.12.006)
  • [L3] Patients with olecranon fractures have essentially similar demographic characteristics compared to patients with distal radius fractures. [47] (10.1177/17585732221124301)
  • [L5] The guiding principle is to restore a congruent humeroulnar joint and allow restoration of upper extremity function. [48] (10.1016/j.jhsa.2014.05.014)
  • [L5] Proximal ulnar osteotomy improves the visualization of the distal humeral articular surface. [50] (10.1016/j.jhsa.2021.11.010)
  • [L4] Transosseous suture with high strength thread is a valid alternative for treating Mayo IIA olecranon fractures in adult patients, decreasing re-operation rates for implant removal. [52] (10.1016/j.injury.2020.02.011)
  • [L4] Displaced olecranon fractures in elderly and medically unwell patients treated nonoperatively can result in reasonable range of motion, minimal pain, and maintenance of extension against gravity. [53] (10.1016/j.jseint.2020.11.001)
  • [L5] Overhead elbow extension in the setting of a displaced olecranon fracture may be maintained if there is any continuity of the extensor mechanism with the ulnar shaft. [54] (10.1016/j.jse.2023.01.005)
  • [Paper] DSTBW technology provides stable fixation for olecranon fractures, reducing the risk of internal fixation migration and failure. [55] (10.1186/s12891-023-06684-4)
  • [L4] The authors describe a novel technique using suture tension band fixation with eyelet wires for simple olecranon fractures and hypothesize satisfactory outcomes regarding pain, functional scores, and radiographic union. [60] (10.1016/j.xrrt.2026.100707)
  • [L4] This review identified a median OA incidence of 19% at a median follow-up of 41 months following isolated olecranon fractures. [61] (10.1016/j.jse.2026.02.024)
  • [L3] Fractures of the ipsilateral olecranon associated with the radial neck are not so rare as previously reported. [62] (10.1186/s13018-021-02373-x)
  • [L3] Professional baseball players who undergo ORIF of an olecranon fracture have a return to sport rate of 67.5%, which is no different from natural attrition among matched controls. [63] (10.1177/0363546519844479)
  • [L2] [67] (10.1016/j.jse.2019.01.002)
  • [L3] Olecranon fractures in the elderly have higher than expected 1 year mortality rates. [68] (10.1177/1758573221994860)
  • [L4] Complication rates, including deep infection and nonunion, are high, with frequent long-term functional limitations posed to the patient. [69] (10.1016/j.jse.2020.07.012)

See Also

References

[1] Efficacy evaluation of Kirschner wire tension band combined with anatomical locking plate in the treatment of Mayo type II olecranon fractures. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08843-1

[2] Timing of Olecranon Fracture Fixation Does Not Affect Early Complication or Reoperation Rates. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2023.09.002

[3] Midterm outcomes of suture anchor fixation for displaced olecranon fractures. Clinics in Shoulder and Elbow. 2024. DOI: 10.5397/cise.2023.00528

[4] Clinical evaluation of double-plate osteosynthesis for olecranon fractures: A retrospective case-control study. Orthopaedics & Traumatology: Surgery & Research. 2019. DOI: 10.1016/j.otsr.2019.08.019

[5] Treatment of Displaced Olecranon Fractures in the Elderly: Should the Pendulum Swing?. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.01097

[6] Olecranon Fractures. Hand Clinics. 2015. DOI: 10.1016/j.hcl.2015.07.003

[7] Further Displacement After Initial Nonsurgical Treatment of Minimally Displaced Olecranon Fractures in Children. Journal of the American Academy of Orthopaedic Surgeons. 2026. DOI: 10.5435/jaaos-d-25-00821

[8] Paediatric olecranon fractures: a systematic review. EFORT Open Reviews. 2020. DOI: 10.1302/2058-5241.5.190082

[9] Risk factors for complications and poor function after open reduction and fixation of olecranon fractures. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2025.08.004

[10] Treatment of Displaced Olecranon Fractures: A Systematic Review. Scandinavian Journal of Surgery. 2019. DOI: 10.1177/1457496919893599

[11] Locked Plating of Geriatric Olecranon Fractures and Early Mobilization Leads to Low Fixation Failure in Patients Over the Age of 75. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.01.027

[12] Olecranon Fractures: Treatment Options. Journal of the American Academy of Orthopaedic Surgeons. 2000. DOI: 10.5435/00124635-200007000-00007

[13] Hardware complications and reoperations following precontoured plate fixation of the olecranon: a population-based study. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.04.006

[14] Olecranon fractures. Injury. 2009. DOI: 10.1016/j.injury.2008.12.013

[15] Modern fixation techniques versus traditional tension band wiring for olecranon fractures: a systematic review and meta-analysis of functional outcomes, healing time, and complications. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06061-y

[16] Intramedullary screw fixation for simple displaced olecranon fractures. European Journal of Trauma and Emergency Surgery. 2019. DOI: 10.1007/s00068-019-01114-4

[17] Nonoperative Management of Olecranon Fractures in Elderly Patients: A Systematic Review. HAND. 2020. DOI: 10.1177/1558944720944261

[19] Surgery for Olecranon Fractures in the Elderly (SOFIE). Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.00655

[20] Epidemiology, classification and treatment of olecranon fractures in adults: an observational study on 2462 fractures from the Swedish Fracture Register. European Journal of Trauma and Emergency Surgery. 2021. DOI: 10.1007/s00068-021-01765-2

[21] Surgical Treatment of Displaced Olecranon Fracture Through a Persistent Physis: Case Report and Review of the Literature. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119881647

[22] Comparison of the Subjective Elbow Value with the DASH, MEPS und Morrey Score after Olecranon Fractures. Zeitschrift für Orthopädie und Unfallchirurgie. 2019. DOI: 10.1055/a-0946-2649

[23] Efficacy and safety of tension band wire versus plate for Mayo II olecranon fractures: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03262-7

[28] A novel fragment specific classification of complex olecranon fractures: 3-dimensional model design, radiological validation, and proposed surgical algorithm. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.12.021

[29] Outcomes of suture tension band technique for fixation of olecranon fractures: a retrospective case series. JSES International. 2025. DOI: 10.1016/j.jseint.2025.04.032

[30] Randomized Prospective Study of Olecranon Fracture Fixation: Cable Pin System versus Tension Band Wiring. Journal of International Medical Research. 2040. DOI: 10.1177/147323001204000324

[31] Is surgery needed for displaced olecranon fractures in patients aged 75 years or over?. Orthopaedics & Traumatology: Surgery & Research. 2021. DOI: 10.1016/j.otsr.2021.103089

[32] Short-term complications of open reduction and internal fixation of olecranon fractures: a national database study. JSES International. 2025. DOI: 10.1016/j.jseint.2025.06.017

[33] Can low-profile double-plate osteosynthesis for olecranon fractures reduce implant removal? A retrospective multicenter study. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.01.091

[35] Bilateral olecranon fracture as first presentation of sarcoidosis: Case report and review of the literature. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.06.016

[36] Long-term outcomes after different types of Horne and Tanzer olecranon fractures. Archives of Orthopaedic and Trauma Surgery. 2020. DOI: 10.1007/s00402-020-03453-z

[40] Classifications in Brief: Mayo Classification of Olecranon Fractures. Clinical Orthopaedics & Related Research. 2018. DOI: 10.1097/corr.0000000000000614

[43] Plate fixation and tension band wiring after isolated olecranon fracture comparison of outcome and complications. Journal of Orthopaedics. 2020. DOI: 10.1016/j.jor.2019.09.017

[44] Trans-olecranon fracture posterior dislocation: a novel type of elbow injury. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03563-5

[45] Wide-Awake Olecranon Fracture Fixation: Is it Possible?. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2022.12.006

[47] Mortality and subsequent fractures of patients with olecranon fractures compared to other upper extremity osteoporotic fractures. Shoulder & Elbow. 2022. DOI: 10.1177/17585732221124301

[48] Surgical Techniques of Olecranon Fractures. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.05.014

[50] Proximal Ulna Osteotomy for Complex Fractures of the Distal Humerus: A 3-Dimensional Laser Analysis and Comparison With Olecranon Osteotomy. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.11.010

[52] Olecranon mayo IIA fractures treated with transosseous high strength suture: A series of 29 cases. Injury. 2020. DOI: 10.1016/j.injury.2020.02.011

[53] Outcomes of nonoperative management of displaced olecranon fractures in medically unwell patients. JSES International. 2021. DOI: 10.1016/j.jseint.2020.11.001

[54] The medial forearm fascia and lateral forearm fascia contribute to overhead elbow extension in displaced olecranon fractures: a biomechanical study. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.01.005

[55] The effect of ding’s screw and tension band wiring for treatment of olecranon fractures: a finite element study. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06684-4

[60] Suture tension band fixation of olecranon fractures: description and early outcomes of a novel technique. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100707

[61] Incidence of Post-traumatic Osteoarthritis in Olecranon Fractures and the Role of Instability and Comminution in its Development: A Systematic Review. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.02.024

[62] Management strategies of pediatric ipsilateral olecranon with associated radial neck fractures based on multicenter experience. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02373-x

[63] Performance and Return to Sport After Open Reduction and Internal Fixation of the Olecranon in Professional Baseball Players. The American Journal of Sports Medicine. 2019. DOI: 10.1177/0363546519844479

[67] Outcome following olecranon osteotomy versus paratricipital approach for complex intra-articular (AO 13-C) fracture of distal humerus: a prospective comparative study. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.01.002

[68] Complications and mortality associated with olecranon fractures in the elderly: a retrospective cohort comparison from a large level one trauma centre. Shoulder & Elbow. 2021. DOI: 10.1177/1758573221994860

[69] Complications and functional outcomes after transolecranon distal humerus fracture. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.07.012

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.