Surgical fixation with wire or plate (most displaced fractures)
Content reviewed by✓Mr Andrew Davies, PhD FRCS (Tr & Orth)· Reviewed June 2026Most olecranon fractures, broken tips of the elbow, require surgery to fix the bone and allow the triceps muscle to work again. Recovery is generally good, though a second operation to remove the metalwork is common.
Step 1, Surgery and early movement
ℹ️ The olecranon is fixed with either a tension band wire (two wires looped together) or a plate and screws. Both techniques allow the elbow to start moving within 1–2 weeks of surgery. Early movement is important, the elbow stiffens quickly if kept still.
Surgery is performed under general anaesthetic and takes 45–75 minutes. Most patients go home the same day or after one night. A posterior plaster splint is sometimes applied for the first 1–2 weeks to protect the repair while healing begins.
Start moving the elbow at 1–2 weeks
Once the splint comes off, active elbow exercises begin. Bending and straightening the elbow should start within the first two weeks. Early movement prevents stiffness.
Keep the arm elevated
Elevating the arm above heart level reduces swelling and pain, particularly in the first 2 weeks. Rest with the arm on pillows.
The metalwork may need removing
Tension band wires commonly become prominent under the skin and cause discomfort. Around 60–70% of patients with wire fixation have a planned second operation (day case) to remove the wires at 12–18 months.
Do not force the elbow
Allow the elbow to move through active exercises only, do not use your other hand to force the range. Forced movement causes scar tissue and worsens the final range.
The day of surgery
ℹ️ You will be given a specific arrival time. Have no food from 2am on the day of surgery; you may drink clear water until 6am. Bring your medication list and any documents sent by the hospital.
Arrive at the time given
You will be admitted to the ward or day surgery unit, change into a gown, and be seen by the nursing, anaesthetic, and surgical teams before theatre.
Consent and marking
Your surgeon will confirm the procedure, mark the operative side, and you will sign a consent form before going to theatre.
Anaesthetic
You will meet the anaesthetist in the anaesthetic room. Once anaesthesia is established, the procedure will begin.
Recovery room
After surgery you will wake in the recovery room where nurses monitor your vital signs until you are stable and comfortable.
In hospital
Most patients having arthroscopic or day-case procedures go home on the day of surgery. Those having joint replacement typically stay 1–2 nights. Before discharge, the team will check your pain is controlled, give you wound care instructions, and confirm your follow-up appointment.
Pain control
You will be given oral pain relief before discharge. Take it regularly for the first 48 hours rather than waiting until pain is severe.
Wound check and dressing
A nurse will check the wound before you leave and explain how to keep it clean and dry.
Discharge letter and follow-up
You will receive a letter for your GP and details of your next outpatient appointment - usually at 2 weeks for a wound check.
You must not drive yourself home
Arrange for a family member or friend to collect you. You must not drive on the day of surgery if you have had a general anaesthetic or sedation.
Going home
⚠️ Important: Contact your team if you notice increasing redness, warmth, or discharge from the wound. Also contact them if the elbow is not gaining movement despite regular exercises, early physiotherapy input is important.
Keep the wound clean and dry
Avoid getting the wound wet until it is fully healed - usually 10–14 days. Use a waterproof cover or cling film when showering.
Take your pain relief as prescribed
Do not wait until pain is severe before taking medication. Regular simple analgesia (paracetamol, ibuprofen if appropriate) is more effective.
Attend your wound check appointment
This is usually 2 weeks after surgery. Sutures or clips will be removed if used.
When to contact the hospital
Seek urgent advice if you develop increasing redness, warmth, swelling, discharge from the wound, or a temperature above 38°C - these may indicate infection.
Recovery week by week
Splint and rest
Posterior splint for 1–2 weeks. Hand and wrist exercises throughout. Arm elevated.
Splint off, movement begins
Splint removed. Active elbow bending and straightening begins. Wound check and stitch removal.
Progressive movement
Range of movement gradually increases. Strengthening exercises added. Return to light driving when elbow is comfortable.
Return to activity
X-ray confirms union. Most daily activities resumed. Return to heavier work when strong enough.
Planned metalwork removal
If wires are prominent and uncomfortable, planned day-case removal at 12–18 months. Full movement usually returns.
Will I definitely need a second operation?
Not definitely, but if you have tension band wire fixation, around 60–70% of patients choose to have the wires removed because they become prominent under the skin and cause irritation. Plate fixation has a lower removal rate (around 20–30%). This is a planned, straightforward day-case procedure under general anaesthetic.
Will I get full movement back?
Full extension of the elbow (fully straight) is usually achievable after olecranon fracture fixation, unlike other types of broken elbow where some permanent stiffness is common. Committing to your exercise programme early gives the best result.
When can I drive?
Most patients return to driving at 6–8 weeks, once the elbow has enough comfortable movement to safely control the vehicle and perform an emergency stop.
Recovery calendar
A week-by-week guide to recovery. Individual timelines vary, always follow your surgical team.
Consent information
Purpose and intended benefits
The aim of surgical fixation is to restore the articular surface of the elbow, reattach the triceps to allow active elbow extension, and achieve stable fixation allowing early physiotherapy to prevent elbow stiffness.
What the procedure involves
Under general anaesthetic, through a posterior elbow incision directly over the olecranon, the fracture is exposed. The fracture is reduced and the articular surface restored. Tension band wiring: two parallel K-wires and a figure-of-eight wire are used to provide compression at the fracture site. Plate fixation: a pre-contoured plate is applied to the dorsal (posterior) surface of the ulna and secured with screws. The ulnar nerve is identified and protected. Takes approximately 45-75 minutes.
Alternative treatments
Non-operative management
Traditionally used for undisplaced, stable fractures without loss of active extension, managed in a splint at 60-90 degrees for 3-4 weeks with careful radiological monitoring. It is also a reasonable option for displaced fractures in older or lower-demand patients, where reasonable everyday elbow function is usually maintained despite frequent non-union, while avoiding the higher surgical complication rate in this group.
Tension band wiring (TBW)
Classic technique. Effective for simple transverse fractures. High rate of hardware prominence requiring planned removal (up to 70%).
Plate fixation
Preferred for comminuted fractures and those with articular involvement. Lower rate of hardware removal in meta-analysis but a more extensive procedure.
Olecranon excision and triceps advancement
For elderly, low-demand patients with severely comminuted fractures. Removes the bony fragment and advances the triceps directly to the remaining ulna.
Risks of the procedure
Failure of the fracture to heal. More common in comminuted fractures. May require revision fixation and bone grafting.
Degenerative arthritis may develop in the repaired joint over years, particularly in fractures with articular surface involvement.
The ulnar nerve runs close to the medial elbow and is at risk during surgery. Injury causes numbness and tingling in the ring and little fingers. Usually temporary.
Wound or deep infection. May require implant removal and antibiotics.
Some permanent loss of elbow extension or flexion may occur despite early physiotherapy.
The most common complication. The wire ends of TBW and the plate used in plate fixation lie directly under thin skin over the olecranon. Symptomatic hardware is the most common reason for a planned second operation to remove hardware.
Expected and managed with regular analgesia.
Normal after olecranon fracture surgery.
Some limitation of movement is expected initially. Physiotherapy begins within 1-2 weeks of surgery.
If you choose not to have surgery
In active or higher-demand patients, a displaced olecranon fracture left unrepaired tends to heal with loss of active extension (difficulty straightening the elbow against gravity), which can limit everyday arm function, so surgery is usually advised. In older or lower-demand patients, non-operative treatment is a reasonable option even when the fracture is displaced: reasonable elbow function for everyday activities is usually maintained despite frequent non-union and some loss of full extension strength, and it avoids the higher complication rate of surgery in this group. The right choice depends on your age, activity level and general health, and should be discussed with your surgical team.
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.