Olecranon fracture fixation is an operation to repair a break in the bony point of the elbow (the olecranon) using metalwork such as a plate and screws, or a tension band wire. This fracture disrupts the triceps mechanism and prevents straightening the arm.
An incision is made over the back of the elbow. The fracture fragments are realigned and held in place with a plate and screws, or with two wires and a figure-of-eight wire loop (tension band wiring). The triceps tendon attachment is restored. The operation usually takes one to one and a half hours.
Most olecranon fractures that are displaced require surgery because the triceps pulls the fracture apart, preventing healing and making it impossible to straighten the elbow against gravity.
Undisplaced fractures may be managed in a cast or splint with close monitoring. In elderly patients with low functional demands, non-operative management may be considered. However, most displaced fractures require surgery.
Surgery is usually performed within days of the injury. Standard pre-operative assessment and fasting are required.
The aim is to restore the ability to straighten the elbow and return to normal function. Most patients achieve good functional outcomes, though some loss of full extension is common.
The olecranon has very little soft tissue covering. Wires and plates can be felt and may cause irritation. Metalwork removal is common.
Some loss of full elbow extension is common after this fracture.
Expected in the early weeks and gradually improving.
Wires can break or migrate. This may require removal.
The fracture may fail to heal, requiring further surgery.
Wound or deep infection around the metalwork.
The ulnar nerve runs close to the olecranon and may be irritated.
General anaesthesia with a regional arm block for pain relief.
Early gentle movement is started within the first few days to prevent stiffness. Heavy lifting is avoided for six to twelve weeks while the fracture heals. Physiotherapy guides rehabilitation. Most patients return to normal activities within two to three months. Metalwork removal is a common secondary procedure if the plate or wires cause irritation.
Wound check at two weeks. X-rays and surgeon review at six weeks and three months.
Approximately 30–50% of patients choose to have prominent metalwork removed after the fracture has healed, usually at around 12 months.
Most patients regain a good functional range. Some loss of the last few degrees of full extension is common but rarely causes functional problems.