Olecranon fractures may be caused by direct injury to the posterior part of the elbow joint or indirectly by forces generated within the triceps muscle during a fall on a partially flexed elbow . The clinical picture is obvious and conventional radiographs are usually sufficient to depict the lesion and the potential associated injuries .
In the herein study, the incidence of olecranon fractures showed a higher prevalence among men until the 5th decade of life and among women in older ages. Similarly, Rommens et al  reported that nearly half of men with olecranon fractures were between 21 to 40 years of age and 40% of women between 61 and 80 years old. Regarding the side of injury, 56.4% of fractures in our series were located in the left limb while Akman et al  observed a predominance of right elbow in 60% of cases.
Tension band wiring (TBW) technique, which is relied on the principle of converting posterior tensile forces to articular compressive forces, has gained widespread acceptance for the surgical treatment of olecranon fractures [17–19]. Many authors have suggested various modifications in order to improve the biomechanical properties of the technique . Rowland and Burkhart  gave an emphasis on the mathematical need to put the transverse hole for the figure-of-eight tension band wire anterior to the intramedullary pin. The above hypothesis wasn't confirmed by Paremain et al  as the results of their biomechanical study indicated no significant differences in yield loads or stiffness values between the Rowland-Murkhart and AO tension band wiring techniques.
In spite of the efficacy of TBW fixation even in cases with severe fracture displacement and comminution, many patients express pain or discomfort due to subcutaneous position of the K-wires and the relevant incidence of metalware removal may be raised to 87% [8–10]. Rommens et al stated that suboptimal pins placement (K-wires which are not inserted parallel or they do not transverse the opposite cortex of the proximal ulna) was not correlated with increased rate of implant loosening or secondary procedures . As the above finding was also evident in our study, we advocate that insertion of K-wires into the anterior ulnar cortex may increase TBW construct stability and stiffness but it couldn't prevent posterior pin migration when active motion of the elbow joint has beeen commenced. Furhermore, hardware removal seems not always to be a panacea for symptoms resolution as 66.6% of TBW removals were still complaining for mild pain or discomfort. Romero et al  noted that backing-out of K-wires and metalwork prominence could not justify alone the need for TBW removal and they should not be considered entirely responsible for patients' subjective complaints.
To avoid hardware problems with TBW technique, some authors have recommended plating osteosynthesis for fracture stabilization [23, 24]. Bailey et al  reported high patient satisfaction (9.7/10) with a low pain rating (1/10) after plate fixation in Mayo types II and III fractures. Although plate removal was performed in 20% of cases the mean DASH score was consistent with almost normal upper extremity function. Hume and Wiss , in a prospective randomized study, found that the application of plates and screws in comparison with TBW construct demonstrated less frequent loss of reduction and better clinical and radiographic results. During the last decade the policy in our department is to use plate fixation when fracture comminution (Types IIB and IIIB) couldn't support compression with the TBW technique. Current low profile, precontoured titanium olecranon plates fit anatomically to the bone, cause less soft tissue irritation, increase fracture stability and allow immediate mobilization of the elbow joint.
Various degrees of postoperative elbow stiffness and deficit of range of motion have been reported in literature after surgical treatment of olecranon fractures [1, 26, 27]. Ring et al  and Teasdall et al  reported that patient compliance, fracture comminution and extension into the ulnar diaphysis or coronoid process, concomitant radial head fracture and elbow instability may lead to inferior results. On the other hand, Villanueva et al  noted that fracture comminution does not necessary have a harmful effect on both clinical and radiological outcome.
Degenerative changes are not uncommon after olecranon fractures and they have been related to the length of follow up . Karlsson et al  found that with a mean of 19 years after isolated olecranon fractures 50% of the patients developed degenerative changes. However, these patients did not report any substantial symptoms and no correlation could be found between radiographic findings and patient subjective outcome. In 48.4% of our patients degenerative changes were identified after an average of 8.2 years postoperatively. The main point is that the functional scores of patients with degenerative changes weren't different of those with normal X-rays. Proper studies and further investigation are required to address the clinical importance of the above issue.
Non-union, ulnar nerve palsy and wound infection have been described in approximately 2–10% of olecranon fractures [4, 27]. Even though the subcutaneous position of the Kirschner wires and their subsequent migration may be responsible for secondary displacement and wound healing problems, careful operative technique and appropriate soft tissue management are of greatest importance in order to minimize the aforementioned complications.