Olecranon fracture malunion treated surgically: A case report highlighting one elbow, four orthopedic surgeons, and two physical therapists.

Authors

Morey J Kolber, William J Hanney

Published in

Physiotherapy theory and practice. Pages 1-12. Jul 08, 2026. Epub Jul 08, 2026.

Abstract

Displaced olecranon fractures often require surgical fixation. A mobility loss following surgery may occur from fibrosis due to immobilization, malunion, and associated diagnoses. This case highlights the diagnostic uncertainty that may arise when postoperative stiffness presents with overlapping mechanical and soft tissue features.
A 14-year-old girl experienced a displaced olecranon fracture with loss of the triceps extensor mechanism following a fall off an electric scooter. Acute surgical fixation healed with a malunion that caused posterolateral impingement and a persistent loss of elbow extension. The initial course of care was protracted over 7-months due to discordance between healthcare providers. Specifically, inter-professional interpretation of end-feel, pain patterns, and imaging were paramount to delays in a necessary surgical revision.
Seven months following the initial surgery, a 20-degree loss of elbow extension with posterior elbow pain and a bone-to-bone end-feel were present, preventing a return to pre-morbid activities. Imaging confirmed an olecranon malunion with posterolateral impingement. Subsequently, the patient underwent arthroscopic revision surgery and a 10-week course of physical therapy. At the 11-month post-revision follow up she resumed pre-morbid kickboxing and weight-training activities pain-free. Elbow strength was symmetrical with 0-135 degrees of elbow mobility. QuickDash was scored 0% and the global rating of change was a 6+.
Persistent stiffness following olecranon fracture fixation may reflect a combination of soft tissue and mechanical factors. When limited progress or an atypical symptom presentation occurs, the integration of clinical findings with appropriate imaging may assist with a differential diagnosis. A diagnostic synthesis integrating clinical and imaging results with the lack of clinical progression was essential for identifying a surgical fixation malunion and need for revision surgery. Physiotherapists should consider posterior impingement in their differential diagnosis when a persistent loss of elbow extension is coupled with posterior elbow pain following a surgical fixation.

PMID:
42417077
Bibliographic data and abstract were imported from PubMed on 08 Jul 2026.

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