When you bend your elbow, you can easily feel its "tip," a bony prominence that extends from one of the lower arm bones (the ulna). That tip is called the olecranon (oh-lek'-rah-nun). It is positioned directly under the skin of the elbow, without much protection from muscles or other soft tissues. It can easily break if you experience a direct blow to the elbow or fall on a bent elbow.

The elbow is a joint made up of three bones. It bends and straightens like a hinge. It is also important for rotation of the forearm; that is, the ability to turn our hands up (like accepting change from a cashier) or down (like typing or playing piano).

• The humerus is the upper arm bone between the shoulder and the elbow.
• The radius is one of the forearm bones between the elbow and wrist. When standing with your palm facing up, the radius is on the "thumb side" of the forearm (the lateral side, "outside").
• The ulna is the other forearm bone between the elbow and wrist, running next to the radius. When standing with your palm facing up, the ulna is on the "pinky side" of the forearm (the medial side, "inside").

The elbow consists of portions of all three bones:

• The distal humerus is the center of the elbow "hinge."
• The radial head moves around the distal humerus and also rotates when the wrist is turned up and down.
• The olecranon is the part of the ulna that "cups" the end of the humerus and rotates around the end of the humerus like a hinge. It is the bony "point" of the elbow and can easily be felt beneath the skin because it is covered by just a thin layer of tissue.

The elbow is held together by three main things:

• Ligaments. Ligaments connect one bone to another.
• Muscles and tendons. Muscles and tendons move the bones around each other.
• Shape of the bone. The way the bones fit together hold the elbow together.

When the elbow structure is altered, either by breaking a bone or by tearing ligaments, muscles, or tendons, or a combination of those problems, then the elbow will not function normally. It can become very painful and stiff, and can cause a feeling of instability ("my elbow feels like it wants to pop out.").

There are many types of elbow fractures (breaks). Olcranon fractures are common. Although they usually occur in isolation (that is, there are no other injuries), they can be a part of a more complex elbow injury.

Olecranon fractures can occur in a number of ways:

• A direct blow. This can happen in a fall (landing directly on the elbow) or by being struck by a hard object (baseball bat, dashboard of a car during a crash).
• An indirect fracture. This can happen by landing on an outstretched arm. The person lands on the wrist with the elbow locked out straight. The triceps muscle on the back of the upper arm help "pull" the olecranon off of the ulna.

• Sudden, intense pain
• Inability to straighten elbow
• Swelling over the bone site
• Bruising around the elbow
• Tenderness to the touch
• Numbness in one or more fingers
• Pain with movement of the joint

A patient with an olecranon fracture will typically go to the emergency room because the elbow will be very painful and unable to move. During the examination the doctor will:

• Examine the skin to see if there are any lacerations (cuts). Lacerations can be caused by fragments of bone and can lead to an increased risk of infection.
• Palpate (feel) all around the elbow to determine if there are any other areas of tenderness. This can indicate other broken bones or injuries, such as a dislocation of the elbow.
• Check the pulse at the wrist to be sure that good blood flow is getting past the elbow to the hand.
• Check to see if the patient can move his or her fingers and wrist, and if the patient can feel things with his or her fingers.
• The doctor may ask the patient to straighten the elbow. Sometimes, the patient will be able to do this, and sometimes the patient will not.
• The doctor may examine the patient's shoulder, upper arm, forearm, wrist, and hand as well, even if the patient only complains of pain at the elbow.

X-rays will be taken of the elbow to confirm that a fracture has occurred. X-rays can also reveal other fractures or dislocations. X-rays may also be taken of the upper arm, forearm, shoulder, wrist, and/or hand, based upon the doctor's judgment and based upon the patient's complaints. These X-rays may reveal other injuries, such as other fractures or dislocations.

While in the emergency room, the doctor will treat an olecranon fracture with ice, pain medicine, a splint (like a cast), and a sling to keep the elbow in position.

Whether or not the fracture requires surgery will be determined. Not all olecranon fractures require surgery.

After surgery, the patient's elbow may be splinted or casted for a short period of time. The patient may wear a sling if it provides comfort. Pain medications may be provided. The surgeon usually removes stitches or staples 10 to 14 days after surgery.

The patient is often restricted from lifting objects with the injured arm for at least six weeks. Motion exercises for the elbow and forearm should begin shortly after surgery, sometimes as early as the day after surgery.

Especially early after surgery, some patients may not be able to straighten their injured elbow on their own. To straighten the elbow, the patient needs to use his/her uninjured arm to help out, or assistance from another person.

Full recovery from an olecranon fracture requires a lot of work. It is extremely important that exercises, once started, are performed multiple times a day, every day. Physical therapy will sometimes be prescribed. If so, the patient should still do exercises at home on days he or she does not work with the therapist. The exercises only make a difference if they're done regularly. Recovering strength often takes longer than expected; sometimes, 6 months or more.

Restrictions on driving are generally based on the arm that is injured (the right arm is used for shifting, for example) and on use of pain medications. Narcotics, such as morphine or codeine, impair judgment and therefore they impair the ability to drive a vehicle just like alcohol does.