summary Olecranon Fractures are common fractures of the elbow that lead to loss of extensor mechanism. Diagnosis can be made with plain radiographs of the elbow. Treatment may be nonoperative for nondisplaced fractures with an intact extensor mechanism. Surgical management is indicated for displaced fractures or fractures associated with loss of extensor mechanism. Epidemiology Incidence 12 per 100,000 per year account for approximately 10% of upper extremity fractures Age mean age is ~57 years Bimodal distribution login to view 2 more bullets Etiology Pathophysiology mechanism login to view 5 more bullets Associated conditions Transolecranon fracture/dislocation login to view 3 more bullets Anatomy Osteology together with coronoid process, forms the greater sigmoid (semilunar) notch greater sigmoid notch articulates with trochlea login to view 2 more bullets Muscles triceps login to view 3 more bullets anconeus login to view 2 more bullets Classification Mayo Classification Based on comminution, displacement, fracture-dislocation Colton Classification Nondisplaced - Displacement does not increase with elbow flexion Avulsion (displaced) Oblique and Transverse (displaced) Comminuted (displaced) Fracture-dislocation (Transolecranon) Schatzker Classification Type A Simple transverse fracture Type B Transverse impacted fracture Type C Oblique fracture Type D Comminuted fracture Type E More distal fracture, extra-articular Type F Fracture-dislocation AO Classification Type A Extra-articular Type B Intra-articular Type C Intra-articular fractures of both the radial head and olecranon Presentation Symptoms pain well localized to posterior elbow Physical exam palpable defect login to view 1 more bullet inability to extend elbow login to view 1 more bullet Imaging Radiographs recommended views login to view 2 more bullets additional views login to view 3 more bullets CT indications login to view 1 more bullet Treatment Nonoperative cast immobilization login to view 6 more bullets Operative open reduction internal fixation (ORIF) login to view 15 more bullets fragment excision and triceps advancement login to view 7 more bullets Techniques Open reduction internal fixation (ORIF) techniques login to view 25 more bullets Excision and triceps advancement technique login to view 1 more bullet Complications Symptomatic hardware most frequent reported complication Stiffness occurs in ~50% of patients usually doesn't alter functional capabilities Heterotopic ossification more common with associated head injury Posttraumatic arthritis Nonunion rare Ulnar nerve symptoms Anterior interosseous nerve injury Loss of extension strength