One Test Decides Whether This Needs Surgery: Can You Straighten It Yourself?
You landed directly on the point of your elbow. It’s swollen, there’s a graze, and it hurts to move.
The olecranon is that bony point.
It’s where your triceps tendon attaches to, and it forms the back half of the elbow joint itself, which is why a break here is a joint injury rather than just a broken bone.
The test that matters: with your shoulder out to the side and your arm hanging bent, can you straighten your elbow yourself against gravity?
If you can, the triceps is still connected to something that works and the fracture may be manageable without surgery. If you can’t, the mechanism that straightens your arm has been broken in half, and that needs fixing.
(Don’t force it. If it hurts too much to attempt properly, that’s information too, and it’s a test to do with whoever is assessing you rather than alone at home.)
Why most of these get operated on
The triceps pulls upwards on this bone constantly. So the moment the fracture separates even slightly, the muscle keeps pulling the fragment further away, and the gap tends to widen rather than close.
Two other things stack on top of that.
The fracture surface is part of the joint, so healing with a step or a gap in it leaves an uneven joint surface and arthritis later. And the bone needs to be stable enough to start moving early, because this is an elbow and elbows punish immobility.
Undisplaced fractures, meaning the pieces are still in contact and you can straighten the elbow, can be treated in a splint for a short period, followed by early motion and repeat X-rays to make sure nothing has drifted.
The two operations
- Tension band wiring for simple breaks straight across. Two pins and a wire loop, arranged so that the pull of the triceps compresses the fracture together instead of pulling it apart. Elegant piece of engineering, using the force that caused the problem to fix it.
- A plate and screws for anything shattered into several pieces, or where the joint surface needs rebuilding.
In older patients with fragile bone and low demands, surgeons sometimes deliberately choose neither, accepting a poorer straightening in exchange for avoiding an operation that fragile bone struggles to hold.
The hardware conversation, and have it early
There is almost no soft tissue between the point of your elbow and your skin. Whatever is put in there, you may well be able to feel.
Prominent hardware is genuinely common after tension band wiring, and a substantial proportion of people end up having it removed once the bone has healed.
Enough that it’s worth asking your surgeon about their own rate before the operation rather than being surprised at month six.
Every other joint has padding over the metalwork. This one has skin.
Removal is a smaller operation, usually done after 6 to 12 months, and it reliably solves the discomfort of leaning on the elbow.
Recovery
- Weeks 0 to 2: splint, elevation, wound care. Shoulder, wrist and fingers moving fully from day one. Gentle elbow bending usually starts within this window.
- Weeks 2 to 6: active bending and straightening, and this is the phase that decides your range. No pushing up out of chairs, no pressing, nothing that makes the triceps work hard against resistance, because that is the exact force that pulls the repair apart.
- Weeks 6 to 12: resisted straightening reintroduced gradually. Strengthening starts properly. Bone union usually confirmed on X-ray somewhere here.
- Months 3 to 6: full loading, back to manual work and sport.
The two things I watch for in that window are loss of full straightening, which is common and worth fighting for early, and a triceps that never quite regains its push. Both respond much better to work at week four than to work at month four.
When to get back in touch
- Increasing pain and swelling at the elbow after the first fortnight, or a wound that starts leaking.
- A sudden loss of the ability to straighten it after you’d regained it, which can mean the fixation has failed.
- Numbness or tingling in the ring and little fingers. The ulnar nerve runs in a groove millimetres from this fracture and can be irritated by the injury, the swelling or the hardware.
- Range that has completely stopped improving between weeks 3 and 8.
The short version
Fall onto the point of the elbow: the question is whether you can straighten the arm yourself against gravity.
Can’t do it, and the extensor mechanism is broken and needs fixing. Can do it, and there’s a real chance of avoiding surgery, with early movement and careful X-ray follow-up.
Either way, ask about hardware prominence before the operation, not after.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Tens of thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. Follow your own surgeon’s protocol where it differs from anything here.