Expose the fracture ends and the triceps tendon with minimal soft tissue dissection.
Identify the torn triceps tendon and its expansions.
Remove hematoma and irrigate.
Direct reduction of bone fragments and triceps insertion will follow.
This procedure is normally performed with the patient either in a lateral position or in a supine position for posterior access.
The fracture fragments and triceps are repaired with heavy sutures into the ulna.
Insert one Nr. 5 Mersilene or other non-absorbable suture through the avulsed fragment and make a crisscrossed locking stitch (Krackow suture) into one side of the tendon.
Pass the suture to the other side of the tendon and make another crisscrossed locking stitch back down the tendon and through the avulsed fragment.
Make two parallel holes into the olecranon through the fracture site, directed through the posterior cortex of the ulna.
Pass a suture through each hole. Carefully reduce the avulsed fragment with the tendon by pulling the sutures.
Tie the knot with the elbow in 45 degrees of flexion.
Additional sutures may add support to triceps expansion and/or periosteum.
Observe the repair for stability with the elbow flexed.
Close the wound in layers.
Apply a posterior splint with the elbow in 90 degrees of flexion and the forearm in neutral rotation for one week.
Thereafter the splint is removed and gentle active flexion to 60 degrees and passive extension is allowed. Four weeks after surgery the patient may flex and extend the elbow against gravity.
Full activity without restriction is allowed at six months.