Intramedullary nails are a relatively recent technical option in the management of olecranon fractures. The main theoretical advantage of this technique is minimization of soft-tissue irritation (and need for subsequent hardware removal). In addition, there is evidence that intramedullary nailing may result in less gapping at the fracture site than tension banding when early ROM is instituted. Further clinical investigation is required to determine the optimal indication of this method of fixation. It is interesting to note that some authors have discussed this technique in a broadened indication of treating nondisplaced fractures, thereby allowing earlier ROM without concern for loss of fracture alignment. Future study will likely determine the efficacy in this clinical situation.

Most intramedullary devices designed for proximal ulnar fractures are intended for simple, transverse injury patterns. However, one multiplanar, locked intramedullary nail (OlecraNail, Mylad Orthopedic Solutions, Doylestown, PA) is potentially suitable for unstable, comminuted fractures (Figure 8.6). This nail has a fixed-angle design and offers rigid stability in all planes. Similar to the existing locking plates, this particular nail has a fixed-angle design and rigidly stabilizes bone fragments in all planes. In a cadaveric biomechanical study, intramedullary nailing and locked plating demonstrated similar fracture stability under cyclic loading. In addition, there was evidence that nailing held fracture fragments stable under higher maximal loading conditions. It remains unclear whether this is of clinical importance, although this finding may suggest potential benefit where limited load bearing is necessary in the postoperative period. Potential patient groups that would benefit from this include elderly or polytrauma patients. If used in more complex fracture patterns, then strict adherence to techniques of articular surface reduction and restoration is required (similar to that outlined in Plate fixation).