19 elderly patients (75 years or older) with a displaced olecranon fracture were randomized to be managed nonoperatively through immobilization for 2 weeks, or operatively with either tension band wiring or plate fixation. The purpose of this study was to compare 1-year clinical/functional outcomes, complication rate, and cost between groups. No significant differences were observed in the primary clinical measure (Disabilities of the Arm, Shoulder, and Hand questionnaire), or in secondary clinical or functional results, with the exception of a significantly higher range of elbow flexion in the operative compared to nonoperative group. The cost of intervention was significantly higher in the operative group, as was the complication rate within the first year of follow-up, which led to early termination of the study.