Proximal Ulna Fractures

  • Kilian WegmannEmail author
  • Michael Hackl
  • Klaus J. Burkhart
Part of the Strategies in Fracture Treatments book series (SFT)


Fractures of the olecranon are common in adults and can be complex lesions. Triceps pull is acting as a dislocating force. The soft tissue envelope at the back of the proximal ulna is only tenuous. In fractures following direct trauma, accompanying soft tissue lesions are common. Combined with swelling by fracture hematoma and oedema, skin closure can be challenging. Bulky implants increase the risk of wound healing issues. As another factor, fracture configuration and bone quality play an important role in fixing these lesions. While conservative treatment has been advocated only for low demand patients, non-comminuted simple fractures are amenable to cerclage techniques. With figure of eight cerclages, strong fixation is feasible. However, the procedure should not be seen as a particularly easy procedure. Misplacement of the wires may lead to failure of the construct. Incomplete burial of the cerclage locks may lead to iatrogenic complications with wound healing. The comminuted fractures should be fixed using osteosynthesis plates. On the market, different types of plates are available. Standard 3.5 LCP can help to stabilize uncomminuted distal olecranon fractures. The comminuted fractures of the proximal portion of the olecranon demand specific features of the plates, so that the sometimes small proximal fragment can securely be stabilized with as many screws as possible. As a new concept, double plating of the olecranon is being done with one plate at the medial aspect of the olecranon and a second one on the lateral aspect. In that way, the plates can be hidden under the anconeus muscle laterally and the flexor carpi ulnaris muscle medially. By that, optimal soft tissue management is possible. Whether double plating of the olecranon is of significant benefit will be investigated by clinical studies in the future.


  1. 1.
    Karlsson MK, Hasserius R, Karlsson C, Besjakov J, Josefsson PO. Fractures of the olecranon: a 15- to 25-year followup of 73 patients. Clin Orthop Relat Res. 2002;403:205–12.CrossRefGoogle Scholar
  2. 2.
    Rommens PM, Schneider RU, Reuter M. Functional results after operative treatment of olecranon fractures. Acta Chir Belg. 2004;104(2):191–7.CrossRefGoogle Scholar
  3. 3.
    Amis AA, Miller JH. The mechanisms of elbow fractures: an investigation using impact tests in vitro. Injury. 1995;26(3):163–8.CrossRefGoogle Scholar
  4. 4.
    Morrey BF. Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid. Instr Course Lect. 1995;44:175–85.PubMedGoogle Scholar
  5. 5.
    Colton CL. Fractures of the olecranon in adults: classification and management. Injury. 1973;5(2):121–9.CrossRefGoogle Scholar
  6. 6.
    Muller ME, Allgower M, Schneider R, Willenegger H. Comprehensive classification of fractures of long bones. Berlin: Springer; 1991.Google Scholar
  7. 7.
    An KN, Morrey BF, Chao EY. The effect of partial removal of proximal ulna on elbow constraint. Clin Orthop Relat Res. 1986;209:270–9.Google Scholar
  8. 8.
    Bell TH, Ferreira LM, McDonald CP, Johnson JA, King GJ. Contribution of the olecranon to elbow stability: an in vitro biomechanical study. J Bone Joint Surg Am. 2010;92(4):949–57.CrossRefGoogle Scholar
  9. 9.
    Morrey BF, An KN. Stability of the elbow: osseous constraints. J Shoulder Elbow Surg. 2005;14(1 Suppl S):174S–8S.CrossRefGoogle Scholar
  10. 10.
    Sanchez-Sotelo J, O’Driscoll SW, Morrey BF. Anteromedial fracture of the coronoid process of the ulna. J Shoulder Elbow Surg. 2006;15(5):e5–8.CrossRefGoogle Scholar
  11. 11.
    Athwal GS, Faber KJ, King GJ, Elkinson I. Crista supinatoris fractures of the proximal part of the ulna. J Bone Joint Surg Am. 2014;96(4):326–31.CrossRefGoogle Scholar
  12. 12.
    Beser CG, Demiryurek D, Ozsoy H, Ercakmak B, Hayran M, Kizilay O, et al. Redefining the proximal ulna anatomy. Surg Radiol Anat. 2014;36(10):1023–31.CrossRefGoogle Scholar
  13. 13.
    Rouleau DM, Faber KJ, Athwal GS. The proximal ulna dorsal angulation: a radiographic study. J Shoulder Elbow Surg. 2010;19(1):26–30.CrossRefGoogle Scholar
  14. 14.
    Puchwein P, Schildhauer TA, Schoffmann S, Heidari N, Windisch G, Pichler W. Three-dimensional morphometry of the proximal ulna: a comparison to currently used anatomically preshaped ulna plates. J Shoulder Elbow Surg. 2012;21(8):1018–23.CrossRefGoogle Scholar
  15. 15.
    Veillette CJ, Steinmann SP. Olecranon fractures. Orthop Clin North Am. 2008;39(2):229–36, vii.CrossRefGoogle Scholar
  16. 16.
    Gallucci GL, Piuzzi NS, Slullitel PA, Boretto JG, Alfie VA, Donndorff A, et al. Non-surgical functional treatment for displaced olecranon fractures in the elderly. Bone Joint J. 2014;96-B(4):530–4.CrossRefGoogle Scholar
  17. 17.
    Bateman DK, Barlow JD, vanBeek C, Abboud JA. Suture anchor fixation of displaced olecranon fractures in the elderly: a case series and surgical technique. J Shoulder Elbow Surg. 2015;24(7):1090–7.CrossRefGoogle Scholar
  18. 18.
    Brolin TJ, Throckmorton T. Olecranon fractures. Hand Clin. 2015;31(4):581–90.CrossRefGoogle Scholar
  19. 19.
    Newman SD, Mauffrey C, Krikler S. Olecranon fractures. Injury. 2009;40(6):575–81.CrossRefGoogle Scholar
  20. 20.
    Schneider MM, Nowak TE, Bastian L, Katthagen JC, Isenberg J, Rommens PM, et al. Tension band wiring in olecranon fractures: the myth of technical simplicity and osteosynthetical perfection. Int Orthop. 2014;38(4):847–55.CrossRefGoogle Scholar
  21. 21.
    Willinger L, Lucke M, Crönlein M, Sandmann GH, Biberthaler P, Siebenlist S. Malpositioned olecranon fracture tension-band wiring results in proximal radioulnar syostosis. Eur J Med Res. 2015;20:87.CrossRefGoogle Scholar
  22. 22.
    Erturer RE, Sever C, Sonmez MM, Ozcelik IB, Akman S, Ozturk I. Results of open reduction and plate osteosynthesis in comminuted fracture of the olecranon. J Shoulder Elbow Surg. 2011;20(3):449–54.CrossRefGoogle Scholar
  23. 23.
    Tarallo L, Mugnai R, Adani R, Capra F, Zambianchi F, Catani F. Simple and comminuted displaced olecranon fractures: a clinical comparison between tension band wiring and plate fixation techniques. Arch Orthop Trauma Surg. 2014;134(8):1107–14.CrossRefGoogle Scholar
  24. 24.
    Matar HE, Ali AA, Buckley S, Garlick NI, Atkinson HD. Surgical interventions for treating fractures of the olecranon in adults. Cochrane Database Syst Rev. 2014;11:CD010144.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Kilian Wegmann
    • 1
    Email author
  • Michael Hackl
    • 1
  • Klaus J. Burkhart
    • 2
  1. 1.Department of Orthopedic and Trauma SurgeryUniversity Hospital of CologneCologneGermany
  2. 2.Arcus SportklinikPforzheimGermany

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