Approximately 10% of fractures about the adult elbow consist of fractures of the olecranon process of the ulna and range from simple nondisplaced fractures to complex fracture–dislocations of the elbow. Several treatment options for internal fixation have been described, including tension-band wiring, plate fixation, intramedullary screw fixation, and triceps advancement after fragment excision. The method of internal fixation is chosen based primarily on fracture type. Because olecranon fractures are all intra-articular injuries, they require anatomic or essentially normal surface reduction and trochlear notch contour for predictable outcomes. In addition, fixation must be stable enough to permit early mobilization to avoid significant elbow stiffness. Given the variability in fracture patterns, the complex anatomy, and associated injuries, treating surgeons must be familiar with multiple treatment methods and follow a systematic surgical strategy to avoid complications and achieve reliable outcomes.