Olecranon fracture
Content reviewed by✓Mr Andrew Davies, PhD FRCS (Tr & Orth)· Reviewed June 2026A break of the bony tip of the elbow, the part you can feel as a hard knob when you bend your arm. Most displaced breaks need surgery to fix them back together, so that the triceps muscle can still straighten the arm.
📊 These breaks make up around 1 in 10 of all elbow fractures in adults. They occur in two main groups: younger people after a fall directly onto the elbow, and older people with thinner bones after a similar fall.
What is an olecranon fracture?
The tip of the elbow is a bony bump that sticks out at the back. This is where the triceps muscle, the muscle that straightens the arm, attaches. A break of this bony tip pulls apart easily because the triceps muscle keeps pulling on the upper piece. If the pieces are pulled apart, the muscle cannot do its job and the arm cannot be straightened against gravity.
Surgery is offered for most displaced breaks. The goal is to put the broken pieces back together so that the joint surface inside the elbow is restored, and so that the triceps muscle can pull on a solid bone again. This allows you to start moving the elbow early, which is the key to avoiding long-term stiffness.
You may need a second small operation later to remove the metalwork that was used to fix the bone. Metal wires or plates near the skin at the back of the elbow can be uncomfortable, especially when leaning on a table. Around 1 in 2 patients have their hardware removed at some point.
Common causes
- A direct blow to the back of the elbow (the most common cause in lower-energy injuries)
- Falls onto an outstretched hand, where the triceps muscle pulls the bone apart
- Higher-energy injuries such as road traffic accidents and falls from a height
- Falls in older people with thinner bones
- Rarely, a break through bone weakened by previous surgery or by disease
Who is at risk? Young active people and older people with thinner bones form the two main groups. Patients with rheumatoid arthritis are at higher risk because of weakened bone at the elbow. Previous surgery in the area can make the bone more vulnerable to a future break.
Symptoms
Symptoms vary depending on the severity and duration of the condition. Common symptoms include:
- Pain and swelling over the tip of the elbow straight after the injury
- Inability to straighten the elbow against gravity (a key sign of a displaced break)
- A gap or step felt at the back of the elbow under the skin
- Bruising at the back of the elbow that spreads down the forearm
- Pain when trying to bend or straighten the elbow
When to seek help: Go to A&E after a significant elbow injury. If you cannot straighten the elbow against gravity, the bone is almost certainly displaced and surgery will most likely be needed.
How is it diagnosed?
Your surgeon will take a detailed history and examine the joint. The following investigations may be arranged to confirm the diagnosis:
- Examination of the elbow, looking for a step in the bone and asking you to try to straighten the arm
- X-rays of the elbow, taken from the front and the side
- A CT scan in more complex breaks, especially where the joint surface is shattered
- Checking the ulnar nerve, which runs just under the skin on the inner side of the elbow
The side-view X-ray is the most useful one. A gap of more than about 2 mm between the broken pieces, together with an inability to straighten the elbow, almost always means surgery will be needed.
Treatment pathway
Treatment is tailored to the severity of the condition, your age, activity level, and overall health. Most conditions are treated in a stepwise fashion, starting with the least invasive options.
Sling and gentle movement
A small number of breaks are in such a good position that they do not need surgery. The elbow is supported in a sling for a couple of weeks, with very gentle movement to stop it stiffening. Regular X-rays are taken to make sure the bone has not moved.
Surgery with wires or a plate
Most displaced breaks are fixed with surgery. The surgeon makes a small cut over the back of the elbow and puts the pieces back together. Simple breaks are often fixed with two long wires and a loop of strong wire that holds the pieces together. More complex breaks need a metal plate and screws. The triceps muscle is then reattached to the bone.
Sling, accepting some loss of straightening
In very frail patients who would not tolerate surgery well, treatment in a sling is sometimes chosen even when the bone has moved. The arm may not straighten as well as before, but the elbow remains comfortable for daily activities.
Recovery
Physiotherapy starts within a week or two of surgery to prevent the elbow stiffening. Some discomfort at the back of the elbow over the metalwork is common, especially when leaning on the elbow. Many patients eventually have a second small operation to take the metalwork out. Long-term, most people get back to nearly normal function.
- Surgery: Within days of injury
- Physiotherapy starts: Week 1-2 after surgery
- Most pain settles: 6-12 weeks
- Bone fully healed: 3-6 months
- Hardware removal (if needed): 6-12 months after first surgery
What results can I expect?
Healing rates after surgery are very high (more than 9 in 10). Most people regain enough movement for daily activities. Around 1 in 4 patients need their metalwork removed later because it causes discomfort, but this is a small operation with quick recovery.
Elbow tip fracture - surgery and metalwork removal
Common activity questions for this condition. Timelines are approximate, always follow the specific guidance given by your surgeon and physiotherapist.
| Activity | Typical timeline | Notes |
|---|---|---|
| Drive | Weeks 6–8 | When elbow has adequate comfortable movement and grip strength for safe control. |
| Return to desk work | Weeks 3–4 | When elbow movement allows keyboard use. |
| Manual work | Months 2–4 | When union confirmed on X-ray and strength is adequate. |
| Sport | Months 3–4 | Non-contact sport when X-ray confirms union. Contact sport after confirmed healing and strength. |
| Hardware removal | Months 12–18 | If wires or plate are prominent and uncomfortable, planned day-case removal at 12–18 months. Not urgent. |
| Full elbow extension | Months 2–4 | Full extension is usually achievable, unlike other elbow fractures. Commit to daily exercises. |
Common concerns during recovery, and whether they are expected.
Your questions, answered
Plain-English answers to the things people most often ask, drawn from real patient questions and grounded in published guidance. Tap a question to open it.
About thisWhat is an olecranon fracture?
It is a break of the bony point of the elbow, usually from a fall onto the elbow. Because the triceps muscle pulls on this bone, straightening the elbow against resistance is often weak after the injury.
Your choiceDo I need surgery?
Displaced breaks are often fixed surgically, with wires or a plate, so the elbow can straighten and move. Some undisplaced breaks are managed without surgery in a sling or splint. Your surgeon advises based on the pattern.
Getting backWhat is recovery like?
Early guided movement helps avoid stiffness. The bone heals over several weeks, and full movement and strength can take a few months to return.
MetalworkWill the metal be removed?
Wires or plates near the skin at the point of the elbow can sometimes be prominent or irritating. If they are, they can often be removed once the bone has healed.
Pain & medsHow do I manage pain and swelling?
Pain relief, keeping the arm elevated to settle swelling, and starting the movements you are given.
UrgentWhen should I seek urgent help?
Hand numbness, tingling or weakness, a cold or pale hand, severe swelling, or a wound becoming hot, red or discharging.
WellbeingI am worried about elbow stiffness.
Stiffness is common after elbow injuries, and physiotherapy is the key to recovering movement. Raise any concerns about progress early.
- NHS: Broken arm or wrist
- Versus Arthritis: Elbow pain
- British Elbow & Shoulder Society: Exercises for elbow stiffness
- British Elbow & Shoulder Society: Patient information
These links are to UK clinical guidance and patient information from recognised organisations. This page is for general information and does not replace personalised advice from your own clinical team.
Preparing for surgery?
Read our step-by-step guide - what to expect before, during, and after your procedure.
How is it diagnosed?
- ✓Examination of the elbow, looking for a step in the bone and asking you to try to straighten the arm
- ✓X-rays of the elbow, taken from the front and the side
- ✓A CT scan in more complex breaks, especially where the joint surface is shattered
- ✓Checking the ulnar nerve, which runs just under the skin on the inner side of the elbow
Recovery milestones
- ●Surgery: Within days of injury
- ●Physiotherapy starts: Week 1-2 after surgery
- ●Most pain settles: 6-12 weeks
- ●Bone fully healed: 3-6 months
- ●Hardware removal (if needed): 6-12 months after first surgery