Introduction: The olecranon is the proximal articular portion of the ulna. Olecranon fractures account for approximately 8–10% of all elbow fractures. These injuries can result from high-energy trauma, simple falls, forced hyperextension, or triceps avulsion. Surgical intervention is often necessary, but there remains ongoing debate regarding the optimal treatment method—tension band wiring (TBW) versus plating.

Objectives: To evaluate the functional outcomes of olecranon fractures treated with tension band wiring and to analyse the factors influencing these outcomes.

Materials and Methods: This prospective study was conducted at Government Medical College, Thrissur, from February 2, 2021, to February 2, 2022. A total of 22 patients with displaced, non-comminuted olecranon fractures—specifically Mayo Type 2A and 3A—were selected based on defined inclusion criteria. All patients underwent open reduction and internal fixation using tension band wiring with Kirschner wires and stainless steel wire. Patients were followed for a minimum of six months, and functional outcomes were assessed using the Mayo Elbow Performance Index (MEPI) score.

Results: Of the 22 patients included in the study, 14 were male and 8 were female. The majority of cases (64%) occurred in individuals over the age of 50. Simple falls were the most common cause of injury overall, while road traffic accidents were more frequent in younger patients. Two patients developed postoperative infections, and nine experienced joint stiffness. At final follow-up, 14 patients (63.64%) had excellent outcomes, and 6 patients (27.27%) achieved good results according to the MEPI score. The average time to fracture union was 12.4 weeks.

Conclusion: This prospective study demonstrates that open reduction and internal fixation of displaced, non-comminuted olecranon fractures using tension band wiring provides good to excellent functional outcomes in most cases. Tension band wiring remains a reliable and effective technique for managing this type of fracture, with satisfactory radiological and clinical results.