Question 1

Why can't this fracture heal with just a cast?

Accepted Answer

Olecranon fractures nearly ALWAYS require surgery (90-95% surgical) because the triceps muscle attaches to the olecranon and constantly pulls the fracture fragment proximally (upward) away from the main ulna bone - casting cannot counteract this powerful muscle force, so fragment displaces during cast treatment causing non-union and permanent weakness. BIOMECHANICS: Triceps is one of the strongest upper extremity muscles (generates 50-100kg force during arm extension). Triceps tendon inserts directly onto olecranon (the elbow point you can feel under your skin). When olecranon fractures, triceps pulls bone fragment proximally. Even in a cast holding elbow bent (which relaxes triceps somewhat), muscle tone and gravity still create displacement forces. Studies show 60-80% of olecranon fractures displace >5mm during cast treatment despite initial acceptable position. NON-UNION CONSEQUENCE: If fragment doesn't heal (non-union), you cannot actively extend your elbow (lift forearm off table when elbow bent). This is devastating functionally - cannot push yourself up from chair, cannot do push-up motion, cannot lift objects above shoulder height. Permanent 40-60% extensor strength loss even if fragment eventually fibrous heals to ulna. SURGERY FIXES THE PROBLEM: Tension band wiring converts triceps pull into compression force (every time triceps contracts, it compresses fracture together rather than pulling it apart - promotes healing). This biomechanical principle allows early motion (week 2) while protecting fracture. 85-95% union rate with surgery vs 40-60% non-surgical. EXCEPTION: Truly non-displaced fractures <2mm with intact triceps (can extend elbow actively against gravity despite fracture) may trial casting - but this is rare <10% of olecranon fractures, and even these have 30-40% failure rate requiring eventual surgery.

Question 2

What is tension band wiring and will I need the wires removed?

Accepted Answer

Tension band wiring uses two metal K-wires and a figure-of-8 stainless steel cable to fix olecranon fractures - it converts the triceps muscle's pulling force into compression force that promotes bone healing (biomechanical principle). 30-50% of patients eventually need the wires removed 12-24 months after fracture heals due to skin irritation from prominent hardware, but removal is elective and outcomes are excellent. HOW IT WORKS: Two parallel K-wires drilled from olecranon tip across fracture into ulna shaft (provides axial stability, prevents rotation). Figure-of-8 steel wire looped around proximal K-wire ends and through hole in ulna distally (creates tension band construct). When triceps contracts (pulls olecranon proximally), force transmitted through figure-of-8 wire → wire pulls K-wires dorsally (toward skin) → K-wires anchored in anterior ulna cortex → cannot pull through → instead K-wires COMPRESS fracture surfaces together plantarward. Result: triceps contraction paradoxically compresses fracture rather than pulling it apart (reverses the pathologic distraction force). HARDWARE IRRITATION: K-wires sit just beneath skin at olecranon (olecranon has minimal soft tissue coverage - subcutaneous bone you can feel). Wire ends often palpable, tender to touch (leaning on elbow painful). Some patients notice clicking or catching sensation with elbow motion (wire rubbing on soft tissue). 30-50% of patients request hardware removal 12-24 months after fracture heals (elective procedure - remove wires in clinic or day surgery, takes 15-30 minutes). REMOVAL TIMING: NOT removed until fracture solidly healed 12+ months (X-ray shows complete union, fracture line disappeared). Removal too early risks re-fracture (bone not fully remodeled). Most surgeons wait 12-24 months. OUTCOMES AFTER REMOVAL: 90-95% complete relief of hardware irritation symptoms. Elbow function unchanged (fracture already healed, wires not load-bearing after union). Small risk of re-fracture <5% if removed too early or significant trauma after removal. Costs: removal $3k-6k private (simpler procedure than original fixation), public covered (elective, may wait 2-6 months).

Question 3

How much elbow stiffness should I expect and will I regain full motion?

Accepted Answer

Expect to lose 10-30 degrees of elbow motion compared to your uninjured side even with successful surgery and physiotherapy - complete motion recovery is uncommon (20-30% of patients achieve <10 degree loss), most (60-70%) have 10-30 degree loss but maintain functional arc (30-130 degrees sufficient for daily activities), and 10-20% have significant stiffness >30 degrees requiring prolonged therapy or release surgery. NORMAL ELBOW: 0-140 degrees (full extension 0, full flexion 140). FUNCTIONAL ARC: 30-130 degrees (Morrey's arc - adequate for eating, grooming, dressing, most work). POST-OLECRANON FRACTURE TYPICAL: 20-120 degrees (lose 10-20 degrees extension, lose 10-20 degrees flexion, total 100-110 degree arc vs normal 140 - functional but not normal). WHY STIFFNESS OCCURS: Intra-articular fracture (olecranon forms elbow joint surface - fracture damages cartilage, causes inflammatory adhesions). Immobilization period (even brief 1-2 week splint causes measurable elbow capsule contracture - elbow joint especially prone to stiffness). Heterotopic ossification 5-15% (extra bone forms in elbow capsule/collateral ligaments - mechanical block to motion). Fracture comminution (more severe injury → more scarring → worse stiffness). MAXIMIZING MOTION RECOVERY: Start motion EARLY (week 2 post-op in hinged brace - each day delay increases permanent stiffness). Aggressive physiotherapy (2-3x/week months 2-6 - passive stretching, contract-relax techniques, joint mobilization). Home program compliance critical (stretch 3-4x daily 10-15 minutes - patient effort more important than surgery quality for final motion). Static progressive splinting if plateau <100 degrees at 3-4 months (serial splinting gradually regains 10-20 degrees motion in dedicated patients). REALISTIC EXPECTATIONS: Excellent result (lose <10 degrees): 20-30% patients. Good result (lose 10-30 degrees, functional arc >100 degrees): 60-70%. Fair result (lose 30-50 degrees, arc 70-100 degrees): 10-15%. Poor result (lose >50 degrees, arc <70 degrees, severe disability): 5% (usually from comminuted fractures, delayed treatment, or poor therapy compliance). If severe stiffness persists after 6-12 months aggressive therapy, surgical capsular release considered (adds 20-40 degrees in 60-70% but requires repeat intensive PT post-op).

Medical Disclaimer

Olecranon Fractures (Elbow Point Fracture)

📖What is Olecranon Fractures (Elbow Point Fracture)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention