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Combined lateral condyle mass and olecranon fractures are infrequently seen. These cases are easily missed, and only 12 previous cases are detailed in the English medical literature. The decision for surgical fixation usually depends on the amount of displacement of the individual fractures. However, the optimal surgical approach or technique for open reduction and internal fixation has not been agreed upon. We present three original case reports and analyse them together with all other known cases in the English literature. We discuss how to avoid missing these combined fractures and propose a treatment algorithm based on the different permutations of the fracture displacement. Our detailed surgical approach (using a posterior ‘olecranon osteotomy’ approach) is also described.