Epidemiology
- Uncommon in children, usually adolescents
- Olecranon ossification centre appears at about 10 years
Aetiology
- Flexion injury with triceps pull causes transverse fractures
- Extension or varus valgus loads cause oblique metaphyseal fractures
- Apophyseal avulsion in a young child should prompt consideration of osteogenesis imperfecta
Clinical Features
- Posterior elbow swelling and pain
- Loss of active extension against gravity suggests displacement
Investigations
- AP and lateral elbow radiographs
- Compare with the opposite elbow to separate apophysis from fracture
- Look for radial neck fracture and radial head dislocation
Differential Diagnosis
- Normal unfused olecranon apophysis
- Monteggia equivalent injuries
Management
- Undisplaced fractures under 2 mm treated in an above elbow cast for 3 to 4 weeks
- Displaced fractures treated with tension band technique
- Absorbable suture can replace wire to avoid removal
- Oblique metaphyseal fractures can be fixed with a lag screw
- Treat associated radial neck fractures
Complications
- Prominent symptomatic hardware
- Loss of reduction
- Elbow stiffness, less frequent than in adults
- Nonunion is rare
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.