Signs and Treatment for an Olecranon Fracture

An olecranon fracture is a break of the bone that forms the point in the back of your elbow. This olecranon bone is actually the end of the ulna, and it is the attachment of the powerful triceps muscle of the arm.

The triceps muscle straightens your elbow, and an olecranon fracture can impair your ability to straighten your elbow joint.

Common causes of olecranon fractures include:

• Falling directly on the back of the elbow
• Avulsion fracture (the triceps muscle pulling off a fragment of bone from the elbow)
• Stress fractures, most commonly seen in athletes, including baseball pitchers

Symptoms of Olecranon Fracture

After an injury, an olecranon fracture can cause pain of the elbow or difficulty moving the elbow. 

Symptoms of an olecranon fracture include:

• Pain behind the elbow
• Difficulty bending the elbow joint
• Swelling and bruising of the elbow
• Deformity of the bone behind the elbow
• Feeling like the elbow is going to "pop out" of place

Diagnosis

Your healthcare provider might diagnose your olecranon fracture based on your physical examination findings. An X-ray of the elbow can usually visualize the fracture, helping your healthcare provider determine the best course of treatment.

In some more subtle injuries, such as stress fractures, an MRI can be helpful in making the diagnosis.

Treatment

Treatment of an olecranon fracture depends on the amount of displacement of the fracture fragments and the function of the triceps muscle.

If the fracture is non-displaced, or minimally displaced, and the triceps muscle is able to extend the elbow, then surgery may not be necessary. In these cases, protection from activity with a splint or sling will generally allow the fracture to heal over time.

Otherwise, surgical treatment of olecranon fractures is the usual treatment. Sometimes, with an olecranon fracture, bones in the forearm are fractured, and/or the ligaments of the elbow joint can be injured as well.

Surgery

Surgery is the proper treatment when:

• The bone fragments are out of position and the stability or function of the joint is affected
• The triceps muscle is not functioning because of the injury

Surgery is also necessary when the injury causes an open fracture, in which the bone penetrates the skin. This creates a pathway for infection.

During surgical repair of an olecranon fracture, an incision is made over the back of the elbow joint. If you've had an open fracture, your surgeon will clean the bone to lower your chance of infection. The bone fragments are repositioned into the proper location. Pins, wires, screws, or plates may be used to secure the bone fragments in the proper position.

After surgery, you can expect your elbow to be immobilized for a brief period, but the goal is to begin elbow motion as soon as possible. Usually, gentle motion is started within the first weeks following surgery. The amount of motion that's recommended depends on the type of injury and fracture repair.

Complications of Olecranon Fractures

The most common adverse effect of this surgery is persistent pain from the metal pins, wires, and/or screws used to fix the fracture. There is little soft-tissue padding over the back of the elbow, and these metal implants can be bothersome—especially when you lean on your elbow.

In some cases, the metal must be removed after the fracture has healed, usually at least six months after surgery.

Possible complications of surgery include:

• Infection
• Non-healing fractures
• Failure of the fixation to hold the fragments in place
• Elbow pain
• Nerve injury or irritation
• Arthritis
• Heterotopic ossification (extra bone formation that leads to stiffness)

Physical therapy can help you regain full, or almost full, strength and mobility of your elbow joint. More severe injuries can take longer to heal and regain mobility and strength.