Revision Open Reduction and Internal Fixation with Autologous Iliac Crest Bone Grafting for Atrophic Olecranon Nonunion in a Middle-aged Woman

ABSTRACT: Olecranon nonunion is an uncommon complication of proximal ulna fractures that can cause pain, deformity, and functional limitation. It usually arises from inadequate fixation, comminution, or impaired healing biology. Timely surgical intervention is often required to restore elbow function. A 34-year-old female, right-hand dominant homemaker presented with persistent deformity, weakness in extension, and difficulty performing overhead activities 4 months after a conservatively managed right elbow injury. Clinical examination revealed a palpable olecranon defect, and radiographs confirmed an atrophic nonunion. She underwent revision open reduction and internal fixation with a locking compression plate and autologous iliac crest bone grafting. Early rehabilitation was commenced postoperatively. Radiographic union was achieved at 12 weeks, and by 6 months, the patient regained satisfactory function, with a Mayo Elbow Performance Score of 90. Revision fixation with bone grafting provides reliable union and functional recovery in cases of olecranon nonunion. Awareness of this rare but disabling complication is essential, as timely surgical management can restore elbow stability, strength, and patient independence in daily activities.