Is your recovery window still open? Free one-page chart ↓
One Test Decides Whether This Needs Surgery: Can You Straighten It Yourself?
An olecranon fracture takes about 6 to 12 weeks for the bone to heal, and 3 to 6 months to get back to full strength, heavy work and sport. Most need surgery, cos the triceps keeps pulling the break apart.
The exception: an undisplaced break where you can still straighten the elbow yourself against gravity. That one may heal in a splint, with early movement and repeat X-rays.
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, 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.
Get the next 12 weeks wrong in one direction and the repair pulls apart. Get it wrong in the other direction, too careful for too long, and you end up with an elbow that won’t straighten, and a triceps that never quite gets its push back.
Both are avoidable. Here’s how.
Do I need surgery for an olecranon fracture?
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 upward 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.
- It’s a joint surface. Healing with a step or a gap in it leaves an uneven joint, and arthritis later.
- It has to move early. The bone needs to be stable enough to start moving within days to a couple of weeks, 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 (often 1 to 3 weeks), followed by early motion and repeat X-rays to make sure nothing has drifted.
In older people with fragile bone and low demands, surgeons sometimes deliberately choose not to operate even on a displaced break, accepting weaker straightening in exchange for avoiding an operation that fragile bone struggles to hold. Many people do surprisingly well with that trade.
How is an olecranon fracture diagnosed?
- Examination. Swelling and tenderness right on the point of the elbow, sometimes a gap you can feel, and the straightening test above.
- X-ray. The side view shows it best: whether the pieces have separated, by how much, and how many pieces there are.
- CT scan. For shattered (comminuted) breaks, or when the surgeon wants to see the joint surface in 3D before planning the operation.
- Checking what else broke. If the elbow also dislocated, or the radial head broke too, this is a different and more serious injury. See elbow dislocation and radial head fracture.
A soft, squishy swelling on the point of the elbow with no fall, or after leaning on it for weeks, is usually not a fracture at all. That’s olecranon bursitis.
What are the operations for an olecranon fracture?
- 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.
Either way the aim is the same: fixation strong enough that you can start moving the elbow early.
Will I feel the metal? The hardware conversation
Have this one 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 once the bone is solid, and it reliably solves the discomfort of leaning on the elbow.
Olecranon fracture recovery week by week
This is after surgery. Your surgeon’s protocol wins where it differs, because it depends on how secure the fixation was on the day.
- Weeks 0 to 2: splint or sling, elevation, wound care. Shoulder, wrist and fingers moving fully from day one. Gentle elbow bending usually starts within this window. Stitches out around day 10 to 14. See the posterior elbow resting splint.
- 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.
- Months 6 to 12: hardware removal if it’s bothering you. The last few degrees of straightening can keep creeping back.
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.
That’s the window this injury runs on. The first 3 months are the OPEN window for elbow range. After that it starts closing, as the joint capsule tightens around whatever angle it’s been living at, and by around 6 months what you have is mostly what you keep.
Exercises after an olecranon fracture
These are typical. Your surgeon’s limits override anything here, especially on how far you’re allowed to bend in the early weeks.
Weeks 0 to 6: range, no resistance
- Finger fists and full straightens: 10 reps, every hour while awake. Keeps the swelling moving.
- Shoulder movement: arm lifts and shoulder rolls, 10 reps, 3 to 4 times a day. A shoulder parked in a sling for weeks stiffens too.
- Assisted elbow bending: sitting, forearm resting on a table, slide the hand toward you with the other hand helping. 10 reps, 3 to 4 times a day, within your surgeon’s limit.
- Gravity-assisted straightening: lie on your back, arm by your side on a pillow, and let the elbow sink straight with the triceps relaxed. Hold 30 to 60 seconds, 3 to 5 times a day.
- Palm up, palm down: elbow tucked at your side and bent to a right angle, turn the palm up and down slowly. 10 reps, 3 to 4 times a day.
Weeks 6 to 12: gentle load
- Static triceps holds: press the back of your hand gently into a wall or your other hand without moving, about a third of your effort, 5 to 10 seconds, 10 reps. Only once your surgeon clears resisted straightening.
- Light straightening against weight: start with something like 0.5 kg (1 lb). 2 to 3 sets of 10, slow and controlled.
- Wall push-ups: usually later in this window, and only when the static holds are comfortable.
Months 3 to 6: back to real life
Add weight gradually, week by week, as long as the elbow isn’t sore the next morning. Floor push-ups, bench pressing and dips come last.
When can I drive, work and lift after an olecranon fracture?
- Desk work: often 1 to 2 weeks, one-handed at first.
- Driving: once you’re out of the splint and can control the wheel in an emergency, often around 6 weeks. See driving after an injury.
- Light manual work: around 6 to 8 weeks, with no pushing or heavy lifting yet.
- Heavy manual work: commonly 3 to 6 months, once the bone has united and strength has been rebuilt.
- Gym, push-ups and contact sport: around 3 to 6 months, with your surgeon’s go-ahead.
- Leaning on the elbow: may stay uncomfortable until the hardware comes out. That’s the metal, not the healing.
Will my elbow straighten fully again?
Often not quite.
Losing the last 10 to 15 degrees of straightening is common after an olecranon fracture, and most people never notice it in daily life. The arm works fine through that range.
What people DO notice is losing much more than that, or a triceps that can’t push them up out of a chair. Both are worth chasing in the first 3 months. If you’re well short of straight by week 8 to 10 and not gaining, ask for a hand therapy review. A static progressive splint can help, and if the elbow ends up stuck despite everything, there is surgery for a stiff elbow.
Go to the ER if
- Bone is visible, or there’s a wound over the fracture. That’s an open fracture and it needs antibiotics and surgery urgently.
- The hand is cold, pale or blue, or the fingers go numb soon after the injury.
- Severe, escalating forearm pain with tight swelling that isn’t settling with elevation, especially pain when the fingers are stretched. See acute forearm compartment syndrome.
Call your surgeon today if
- A sudden loss of the ability to straighten it after you’d regained it. That can mean the fixation has failed.
- The wound is red, hot, swollen or leaking, or you have a fever. Wires sit close to the skin here.
- A wire end starts poking against or through the skin.
Get it checked if
- Numbness or tingling in the ring and little fingers. The ulnar nerve runs in a groove millimeters 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.
- Increasing pain and swelling at the elbow after the first two weeks instead of less.
The surgeon fixes the bone. The straightening is yours to win in the first 3 months.
Written by Nigel Chua, hand occupational therapist in practice since 2005. 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.
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.