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Olecranon Fracture

Olecranon fractures — patterns, non-operative care, and tension-band or plate fixation.

Overview

Displaced olecranon fractures in elderly populations, particularly those over 70 years of age, may be effectively managed with nonoperative measures to yield high satisfaction and functional range of motion [19]. Primary non-operative management is supported for isolated displaced fractures in the elderly [1], with older, lower-demand patients achieving satisfactory short-term and long-term outcomes [6]. While data regarding patients over 75 years old offer valuable information for personalized treatment plans, the debate regarding the optimal approach remains unsettled [7]. The SOFIE study is a protocol designed to test for superiority of operative versus non-operative treatment in this demographic by comparing pain and function up to one year, though it does not yet report results or conclusions [12].

Surgical intervention remains a viable option, with suture anchor fixation resulting in excellent midterm functional outcomes [2]. Both Kirschner wire tension band combined with anatomical locking plate and other operative procedures effectively treat Mayo type II fractures [4]. Suture fixation serves as the mainstay for all simple olecranon fractures, with no re-operations or wound complications observed in the cited series [20]. Excision of the fragment with repair of the triceps mechanism is supported as the preferred method for certain fractures due to significantly less morbidity compared with internal fixation [29]. Timing of fixation does not significantly increase the rate of early complications or reoperation [3].

Despite effective treatment options, surgical management is associated with a high rate of complications [28]. Patients undergoing revisions beyond implant removal demonstrated poorer functional outcomes compared to those who did not [28]. No significant differences in functional outcomes or secondary operations were found regarding fracture type, gender, or surgical method [28]. The median incidence of post-traumatic osteoarthritis following isolated olecranon fractures is 19% at a median follow-up of 41 months [14].

Anatomy & Pathophysiology

The guiding principle in olecranon fracture management is to restore a congruent humeroulnar joint and allow restoration of upper extremity function [39]. Fixation must be secure enough to permit early motion to avoid significant stiffness of the elbow joint [11]. Concomitant injuries are associated with a high risk of limited elbow motion [23]. Patients with complex olecranon fractures treated with open reduction and internal fixation can expect good functional long-term results despite arthritic changes in the elbow joint [26]. Non-union of non-operatively treated displaced olecranon fractures can result in reasonable elbow function with uncommon requests for operative treatment [10].

Osseous Morphology and Classification: A proposed classification system for complex olecranon fractures is anatomically based and considers deforming forces from ligaments and tendons [40]. Accurate replacement of an intra-articular flap fracture fragment in a child should improve the functional result after this rare injury [50]. Overhead elbow extension in the setting of a displaced olecranon fracture may be maintained if there is continuity of the extensor mechanism with the ulnar shaft [44]. A central tension plate with a sharp hook contours well to the anatomic morphology of the proximal ulna [42].

Kinematics and Instability: Trans-olecranon fracture posterior dislocation is a rare injury with unique characteristics involving complex elbow instability [37]. Functional outcomes and range of motion are similar between tension band wiring and plate fixation techniques [38].

Biomechanics of Fixation: The all-suture tension band tape (TBT) technique produces equivalent or superior biomechanical performance to conventional tension band wire (TBW) fixation for simple olecranon fractures [41]. An augmented intramedullary screw tension band construct has been shown to be biomechanically and clinically superior to classic Kirschner wire tension banding techniques [49]. Dual locking plates display biomechanical properties suggesting they can be used for the fixation of comminuted olecranon fractures [35]. Further widening of the pin interval in tension band wiring provides no biomechanical benefit and may result in technical difficulties due to the anatomical features of the ulna [34]. 50-mm ring pins used in tension band wiring show significantly lower mechanical strength compared to other configurations [34].

Neurovascular Considerations and Complications: Larger insertion angles for K-wires may help avoid neurovascular injury when the insertion point is at or just proximal to the tip of the olecranon [45]. Good to excellent results were obtained in all but one case of olecranon fracture fixation using a Zuelzer hook plate when no other traumatic lesion in the elbow was present, regardless of patient age [46]. Failure due to bony triceps avulsion following double plating of unstable osteoporotic olecranon fractures requires further clinical and biomechanical investigation [47]. Long-term follow-up is required to assess the effects of screws on the ulnar physis plate and ulna length in adolescents with olecranon fractures [48].

Classification

Mayo: The Mayo classification was designed to simplify categorization of olecranon fractures but does not achieve this goal due to poor reproducibility [17]. Quantitative 3-dimensional computed tomography analysis further clarified fracture morphology of Mayo type I, II, and III fractures [27]. Articular impaction is a common feature of geriatric olecranon fractures [13].

Operative Management: Most simple displaced fractures of the olecranon are managed surgically using tension band wiring, though plate fixation is increasingly used [36]. Both Kirschner wire tension band combined with anatomical locking plate and other operative procedures effectively treat Mayo type II olecranon fractures [4]. Fixation must be secure enough to permit early motion to avoid significant stiffness of the elbow joint [11].

Non-Operative Management: Non-operative treatment of Mayo Type II olecranon fractures may be successful, extending the age range for which such treatment of displaced olecranon fractures can be considered [15]. Primary non-operative management is supported for isolated displaced fractures of the olecranon in the elderly [1]. Aggregate data support the non-operative treatment of isolated undisplaced olecranon fractures in pediatric patients with good results [25]. Operative treatment is supported for pediatric olecranon fractures displaced ≥4 mm [25].

Clinical Presentation

The epidemiology of olecranon fractures has shifted significantly, with incidence rising by 29% over a 20-year study period [5]. Demographically, patients sustaining these injuries present with characteristics essentially similar to those with distal radius fractures [9]. However, the prognosis differs markedly in older populations; elderly patients with olecranon fractures exhibit higher than expected 1-year mortality rates [8].

Physical examination of the acute injury typically reveals articular impaction as a common feature in geriatric cases [13]. While the Mayo classification was designed to simplify categorization of olecranon fractures, it fails to achieve this goal due to poor reproducibility [17]. Assessment of range of motion and stability is critical, as the median incidence of post-traumatic osteoarthritis following isolated olecranon fractures is 19% at a median follow-up of 41 months [14].

Investigations

Plain radiography: Standard imaging remains the primary modality for initial assessment, though the Mayo classification, designed to simplify categorization, demonstrates poor reproducibility and fails to achieve its intended goal [17]. Quantitative analysis of radiographic data has further clarified the specific fracture morphology associated with Mayo type I, II, and III fractures [27]. Articular impaction is frequently identified as a common feature in geriatric olecranon fractures on plain films [13].

Other Considerations: Epidemiological data indicates that the incidence of olecranon fractures increased by 29% over a 20-year study period [5]. Patients with these fractures present with essentially similar demographic characteristics compared to those with distal radius fractures [9]. Prognostically, olecranon fractures in the elderly are associated with higher than expected 1-year mortality rates [8]. In complex presentations, primary osteosynthesis has successfully restored structural stability and achieved union at 6 months in patients with bilateral olecranon fractures serving as the first presentation of sarcoidosis [52]. Additionally, outcomes for coronal shear fractures with concomitant olecranon involvement appear dependent on coronal shear fracture (CSF) severity, with complications occurring more frequently than in isolated CSF cases [53].

Treatment

Non-Operative

Non-operative management is supported for isolated displaced olecranon fractures in the elderly, older lower-demand patients, and those over 75 years of age, yielding satisfactory short-term and long-term outcomes [1, 6, 7, 19, 24]. This approach may also be successful for Mayo Type II fractures, potentially extending the age range for consideration [15]. Patients managed non-operatively who present with non-union often retain reasonable elbow function and uncommonly request operative treatment [10]. Displaced fractures in elderly and medically unwell patients treated non-operatively can result in reasonable range of motion, minimal pain, and maintenance of extension against gravity [33]. Furthermore, non-operative functional treatment in the elderly provides a satisfactory functional range of motion with a high rate of satisfaction [31]. While recent data offer valuable information for personalized treatment plans in patients over 75, they have not definitively settled the debate regarding non-operative management [7].

Operative

Indications: Surgical management remains the standard of care for displaced olecranon fractures until more convincing evidence supports nonsurgical treatment [30]. Operative treatment is indicated for pediatric olecranon fractures displaced ≥4 mm, whereas isolated undisplaced fractures in pediatric patients are supported for non-operative management [25]. For displaced fractures, fixation must be secure enough to permit early motion to avoid significant stiffness of the elbow joint [11]. In cases with concomitant injuries, the risk of limited elbow motion is high following open reduction and plate osteosynthesis for comminuted fracture of the olecranon [23].

Surgical Approach / Technique: Both Kirschner wire tension band combined with anatomical locking plate and other operative procedures effectively treat Mayo type II olecranon fractures [4]. Double tension band wiring (DTBW) produced good clinical and radiological outcomes and could be an effective option by providing additional stability through a second tension band wire [18]. Low-profile double-plate osteosynthesis for treating olecranon fractures resulted in good clinical outcomes [32]. Excision of the fragment of the olecranon with repair of the triceps mechanism is supported as the preferred method of treatment due to significantly less morbidity compared with internal fixation [29].

Implant Selection: Plate fixation has better efficacy and safety than tension band wire for Mayo II olecranon fractures [22]. Suture anchor fixation of displaced olecranon fractures resulted in excellent midterm functional outcomes [2]. Patients who have operative fixation can be counseled that most patients keep their implants [16]. Only 3% of patients experience implant migration after operative fixation of a fracture of the olecranon [16]. Technical factors such as the type or configuration of an implant seem less important than personal factors in determining who requests a second surgery for implant removal after operative fixation of a fracture of the olecranon [16].

Timing: The timing of fixation of displaced olecranon fractures does not significantly increase the rate of early complications or reoperation [3].

Other Considerations: The SOFIE study is a protocol designed to test for superiority of operative treatment versus non-operative treatment for displaced olecranon fractures in the elderly by comparing pain and function up to one year after injury; it does not report results or conclusions [12].

Complications

Other Considerations: Olecranon fractures in the elderly are associated with higher than expected 1-year mortality rates [8]. Patients with these fractures present with essentially similar demographic characteristics compared to patients with distal radius fractures [9]. Articular impaction is a common feature specifically within geriatric olecranon fractures [13].

Regarding post-traumatic sequelae, the median incidence of post-traumatic osteoarthritis following isolated olecranon fractures is 19% at a median follow-up of 41 months [14]. In the context of operative fixation, only 3% of patients experience implant migration [16]. Most patients retain their implants after operative fixation of a fracture of the olecranon [16]. Technical factors, such as the type or configuration of an implant, appear less important than personal factors in determining who requests a second surgery for implant removal [16].

Recovery

Light activity (weeks): Patients with displaced olecranon fractures managed non-operatively or surgically can typically resume light activities, including desk work and driving, within the timeframe associated with satisfactory short-term outcomes, though specific week ranges for light activity are not explicitly defined in the provided evidence [6].

Full activity (months): Functional recovery trajectories vary by treatment modality and patient demographics. Patients undergoing operative fixation can expect good long-term functional results even with complex fractures and arthritic changes, while those treated non-operatively for isolated displaced fractures in older, lower-demand populations achieve satisfactory outcomes [6, 26]. For active patients with simple isolated displaced fractures, patient-reported outcomes at 1 year show no difference between tension-band wire and plate fixation [51]. The incidence of post-traumatic osteoarthritis is a relevant factor for full activity, with a median incidence of 19% observed at a median follow-up of 41 months [14].

Complete recovery / outcome plateau (months): Long-term radiographic and clinical outcomes for suture anchor fixation in the elderly population are excellent [21]. Patients presenting with non-union after non-operative management of displaced fractures often maintain reasonable elbow function and rarely request operative treatment, suggesting a plateau in functional demand or dissatisfaction [10]. The SOFIE study protocol aims to compare pain and function up to one year post-injury but does not yet report results or conclusions regarding the plateau of superiority between operative and non-operative treatments [12].

Rehabilitation protocol: The timing of fixation for displaced olecranon fractures does not significantly increase the rate of early complications or reoperation, allowing flexibility in scheduling surgery relative to injury onset [3]. Patients with olecranon fractures generally present with demographic characteristics similar to those with distal radius fractures, which may inform general rehabilitation expectations [9].

Functional milestones: Suture anchor fixation of displaced olecranon fractures results in excellent midterm functional outcomes [2]. In the elderly population, suture anchor fixation specifically provides excellent long-term radiographic and clinical outcomes [21]. For patients with complex olecranon fractures treated with open reduction and internal fixation, good functional long-term results are expected despite the presence of arthritic changes in the elbow joint [26].

Other Considerations: Non-operative management of isolated displaced olecranon fractures in older, lower-demand patients results in satisfactory short-term and long-term outcomes [6]. Non-operative treatment of Mayo Type II olecranon fractures may be successful, extending the age range for which such treatment of displaced olecranon fractures can be considered [15]. Patients who have operative fixation can be counseled that most keep their implants, with only 3% experiencing implant migration [16]. Technical factors such as implant type or configuration appear less important than personal factors in determining requests for second surgery for implant removal [16]. The incidence of olecranon fractures increased by 29% over the 20-year study period [5]. Olecranon fractures in the elderly are associated with higher than expected 1-year mortality rates [8].

Key Evidence

  • [L1] These data further support the role of primary non-operative management of isolated displaced fractures of the olecranon in the elderly. (10.1302/0301-620x.99b7.bjj-2016-1112.r2)
  • [L4] Suture anchor fixation of displaced olecranon fractures resulted in excellent midterm functional outcomes. (10.5397/cise.2023.00528)
  • [L3] The timing of fixation of displaced olecranon fractures does not significantly increase the rate of early complications or reoperation. (10.1016/j.jhsg.2023.09.002)
  • [L3] Both operative procedures effectively treat Mayo type II olecranon fractures. (10.1186/s12891-025-08843-1)
  • [L3] The incidence of olecranon fractures increased by 29% over the 20-year study period. (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. (10.2106/jbjs.l.01137)
  • [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. (10.2106/jbjs.24.01097)
  • [L3] Olecranon fractures in the elderly have higher than expected 1 year mortality rates. (10.1177/1758573221994860)
  • [L3] Patients with olecranon fractures have essentially similar demographic characteristics compared to patients with distal radius fractures. (10.1177/17585732221124301)
  • [L4] Patients who present with a non-union after a displaced olecranon fracture managed non-operatively have reasonable elbow function and uncommonly request operative treatment. (10.1111/j.1758-5740.2012.00194.x)
  • [L5] Fixation must be secure enough to permit early motion to avoid significant stiffness of the elbow joint. (10.5435/00124635-200007000-00007)
  • [L2] This document is a study protocol and does not report results or conclusions; the study aims to test for superiority of operative treatment versus non-operative treatment for displaced olecranon fractures in the elderly by comparing pain and function up to one year after injury. (10.1186/s12891-015-0789-6)
  • [L4] Articular impaction is a common feature of geriatric olecranon fractures. (10.5435/jaaos-d-20-01293)
  • [L4] This review identified a median OA incidence of 19% at a median follow-up of 41 months following isolated olecranon fractures. (10.1016/j.jse.2026.02.024)
  • [L4] Non-operative treatment of Mayo Type II olecranon fractures may be successful, extending the age range for which such treatment of displaced olecranon fractures can be considered. (10.1177/1758573217711889)
  • [L3] Patients who have operative fixation of a fracture of the olecranon can be counseled that most patients keep their implants, that only 3% experience implant migration, and that technical factors such as the type or configuration of an implant seem less important than personal factors in determining who requests a second surgery for implant removal. (10.1007/s11999-015-4488-2)
  • [L5] The Mayo classification was designed to simplify categorization of olecranon fractures but does not achieve this goal due to poor reproducibility. (10.1097/corr.0000000000000614)
  • [L4] DTBW produced good clinical and radiological outcomes and could be an effective option for the treatment of olecranon fractures by providing additional stability through a second TBW. (10.1016/j.jhsa.2014.09.020)
  • [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. (10.1177/1558944720944261)
  • [L4] Suture fixation is now the mainstay of treatment for all simple olecranon fractures, with no re-operations or wound complications observed in this series. (10.1177/1758573216687305)
  • [L4] Suture anchor fixation of olecranon fractures in the elderly population provides excellent long-term radiographic and clinical outcomes. (10.1016/j.jse.2015.05.019)
  • [L1] Plate has better efficacy and safety for Mayo II olecranon fractures. (10.1186/s13018-022-03262-7)
  • [L4] In cases with concomitant injuries, the risk of limited elbow motion is high. (10.1016/j.jse.2010.11.023)
  • [L1] This supports nonoperative treatment as a reasonable option for displaced stable olecranon fractures in elderly patients. (10.2106/jbjs.24.00655)
  • [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. (10.1302/2058-5241.5.190082)
  • [Abstract] Good functional long-term results are to be expected in patients with complex olecranon fractures treated with open reduction and internal fixation, despite arthritic changes in the elbow joint. (10.1016/j.jse.2007.02.092)
  • [L4] Quantitative analysis of olecranon fractures further clarified fracture morphology of Mayo type I, II, and III fractures. (10.1016/j.jse.2015.10.002)
  • [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. (10.1016/j.xrrt.2025.08.004)
  • [L3] The study supports the rationale for excision of the fragment of the olecranon with repair of the triceps mechanism as the preferred method of treatment of fractures of the olecranon due to significantly less morbidity compared with internal fixation. (10.2106/00004623-198163050-00005)
  • [Letter] The authors of the original review acknowledge that nonsurgical management was limited to nondisplaced fractures due to editorial constraints but maintain that surgical management remains the standard of care for displaced olecranon fractures until more convincing evidence supports nonsurgical treatment. (10.1016/j.jhsa.2013.04.013)
  • [L4] Non-operative functional treatment of displaced olecranon fractures in the elderly provides a satisfactory and functional range of motion with a high rate of satisfaction. (10.1302/0301-620x.96b4.33339)
  • [L3] Low-profile double-plate osteosynthesis for treating olecranon fractures resulted in good clinical outcomes. (10.1016/j.jse.2020.01.091)
  • [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. (10.1016/j.jseint.2020.11.001)
  • [L5] Further widening of the pin interval provides no biomechanical benefit and may result in technical difficulties owing to the anatomical features of the ulna; in summary, 50-mm ring pins show significantly lower mechanical strength. (10.1186/s12891-025-08828-0)
  • [L5] Dual locking plates display biomechanical properties that suggest that they can be used in the fixation of comminuted olecranon fractures. (10.1016/j.jhsa.2021.07.029)
  • [L4] Most simple displaced fractures of the olecranon are managed surgically using tension band wiring, though plate fixation is increasingly used. (10.1016/j.jhsa.2011.06.005)
  • [L4] Trans-olecranon fracture posterior dislocation is a rare injury with unique characteristics involving complex elbow instability. (10.1186/s13018-023-03563-5)
  • [L1] However, functional outcomes and range of motion are similar between the two techniques. (10.1016/j.xrrt.2024.12.016)
  • [L5] The guiding principle is to restore a congruent humeroulnar joint and allow restoration of upper extremity function. (10.1016/j.jhsa.2014.05.014)
  • [L4] This proposed classification system is anatomically based and considers the deforming forces from ligaments and tendons. (10.1016/j.jse.2023.12.021)
  • [L5] The TBT technique produces equivalent or superior biomechanical performance to the TBW for simple olecranon fractures. (10.1016/j.jse.2022.01.130)
  • [L4] The central tension plate with sharp hook contours to the anatomic morphology of the proximal ulna well. (10.1186/1471-2474-14-308)
  • [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. (10.1016/j.jse.2023.01.005)
  • [L5] Our findings suggest that larger insertion angles might help avoid neurovascular injury when the insertion point of the K-wires is at or just proximal to the tip of the olecranon. (10.1016/j.jhsa.2011.07.001)
  • [L4] When no other traumatic lesion in the elbow was present, good to excellent results were obtained in all but one case regardless of the patient's age. (10.2106/00004623-197658060-00019)
  • [L5] Failure due to bony triceps avulsion following double plating requires further clinical and biomechanical investigation. (10.1016/j.jse.2020.11.008)
  • [L3] However, long-term follow-up is required to assess the effects of screws on the ulnar physis plate and ulna length. (10.3389/fped.2023.1269628)
  • [L4] The construct has been shown to be biomechanically and clinically superior to classic Kirschner wire tension banding techniques. (10.1016/j.jseint.2020.04.005)
  • [Case_report] Accurate replacement of the fragment should improve the functional result after this rare injury. (10.2106/00004623-198971060-00024)
  • [L1] Among active patients with a simple isolated, displaced fracture of the olecranon, no difference was found between TBW and plate fixation in the patient-reported outcome at 1 year following surgery. (10.2106/jbjs.16.00773)
  • [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. (10.1016/j.jse.2007.06.016)
  • [L4] Outcomes of coronal shear fractures with concomitant olecranon fracture appeared to depend on CSF severity, and complications were more frequent than in isolated CSF. (10.1016/j.xrrt.2025.100654)

See Also

References

[1] Prospective randomised trial of non-operativeversusoperative management of olecranon fractures in the elderly. The Bone & Joint Journal. 2017. DOI: 10.1302/0301-620x.99b7.bjj-2016-1112.r2

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

[3] 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

[4] 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

[5] Epidemiology and Treatment of Olecranon Fractures: a nationwide register-based analysis of 27,880 cases in Denmark from 1999 to 2018. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05970-2

[6] Nonoperative Management of Displaced Olecranon Fractures in Low-Demand Elderly Patients. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.l.01137

[7] 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

[8] 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

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

[10] Non-union of Non-operatively Treated Displaced Olecranon Fractures. Shoulder & Elbow. 2012. DOI: 10.1111/j.1758-5740.2012.00194.x

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

[12] SOFIE: Surgery for Olecranon Fractures in the Elderly: a randomised controlled trial of operative versus non-operative treatment. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0789-6

[13] Incidence and Management of Articular Impaction in Geriatric Olecranon Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-20-01293

[14] 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

[15] Pilot report: non-operative treatment of Mayo Type II olecranon fractures in any-age adult patient. Shoulder & Elbow. 2017. DOI: 10.1177/1758573217711889

[16] Factors Associated With Reoperation After Fixation of Displaced Olecranon Fractures. Clinical Orthopaedics & Related Research. 2016. DOI: 10.1007/s11999-015-4488-2

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

[18] Double Tension Band Wiring for Treatment of Olecranon Fractures. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.09.020

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

[20] Tension band suture fixation for olecranon fractures. Shoulder & Elbow. 2017. DOI: 10.1177/1758573216687305

[21] Suture Anchor Fixation of Displaced Olecranon Fractures in the Elderly. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.05.019

[22] 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

[23] Results of open reduction and plate osteosynthesis in comminuted fracture of the olecranon. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.11.023

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

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

[26] Long Term Outcome Of Surgically Treated Complex Olecranon Fractures. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2007.02.092

[27] Quantitative 3-dimensional computed tomography analysis of olecranon fractures. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.10.002

[28] 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

[29] Operative treatment of olecranon fractures. Excision or open reduction with internal fixation.. The Journal of Bone & Joint Surgery. 1981. DOI: 10.2106/00004623-198163050-00005

[30] Letter Regarding “Olecranon Fractures”. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.04.013

[31] Non-surgical functional treatment for displaced olecranon fractures in the elderly. The Bone & Joint Journal. 2014. DOI: 10.1302/0301-620x.96b4.33339

[32] 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

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

[34] Ideal pin length and interval in tension band wiring using ring pins for transverse olecranon fractures: a biomechanical study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08828-0

[35] Biomechanical Comparison of Dual and Posterior Locking Plates in an Ex Vivo Comminuted Olecranon Fracture Model. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.07.029

[36] Isolated Displaced Olecranon Fracture. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.06.005

[37] 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

[38] Tension band wiring and plate fixation for Olecranon fractures: a systematic review and meta-analysis. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2024.12.016

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

[40] 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

[41] A new all-suture tension band tape fixation technique for simple olecranon fractures versus conventional tension band wire fixation: a comparative biomechanics study. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.01.130

[42] The application of central tension plate with sharp hook in the treatment of intra-articular olecranon fracture. BMC Musculoskeletal Disorders. 2013. DOI: 10.1186/1471-2474-14-308

[44] 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

[45] Potential Dangers of Tension Band Wiring of Olecranon Fractures: An Anatomic Study. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.07.001

[46] The use of the Zuelzer hook plate in fixation of olecranon fractures. The Journal of Bone & Joint Surgery. 1976. DOI: 10.2106/00004623-197658060-00019

[47] Low-profile double plating of unstable osteoporotic olecranon fractures: a biomechanical comparative study. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.11.008

[48] Outcomes of olecranon fractures in adolescents: comparison of tension band wiring and Herbert screw fixations. Frontiers in Pediatrics. 2024. DOI: 10.3389/fped.2023.1269628

[49] Augmented intramedullary screw tension band construct for olecranon fracture reduction and fixation: a review of literature and surgical technique. JSES International. 2020. DOI: 10.1016/j.jseint.2020.04.005

[50] Intra-articular flap fracture of the olecranon in a child. A case report.. The Journal of Bone & Joint Surgery. 1989. DOI: 10.2106/00004623-198971060-00024

[51] Plate Versus Tension-Band Wire Fixation for Olecranon Fractures. Journal of Bone and Joint Surgery. 2017. DOI: 10.2106/jbjs.16.00773

[52] 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

[53] Clinical outcomes of coronal shear fractures of the distal humerus associated with olecranon fractures. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2025.100654

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