Surgical Management for Olecranon Fractures in Adults: A Systematic Review and Meta-analysis

Olecranon fractures are common upper-extremity fractures amenable to various surgical techniques. The authors conducted a systematic review and metaanalysis to evaluate surgical management strategies for olecranon fractures in adult patients. Two investigators independently screened articles from records obtained from MEDLINE, Embase, SPORTDiscus, CINAHL, and the Cochrane Library databases. The authors compared tension-band wiring (TBW) with plate fixation (PF) for the outcomes of complications and hardware removal. Subgroup analyses were conducted comparing randomized controlled trials with observational studies for each outcome. In addition, the authors evaluated novel fixation techniques other than TBW and PF. Twenty-four studies were included in the systematic review and 10 studies were included in the metaanalysis of TBW vs PF. Compared with TBW (n=270), patients who underwent PF (n=369) had a significantly lower complication rate (relative risk, 0.48; 95% confidence interval, 0.36-0.64; P<. 01; I-2=16%). Plate fixation (41 of 332) also had less hardware removal compared with TBW (79 of 236; relative risk, 0.36; 95% confidence interval, 0.25-0.50; P<. 01; I-2=0%). Subgroup analyses showed no difference when comparing randomized controlled trials with observational studies for the outcomes of complication rate (P=. 45) and hardware removal (P=. 54). Qualitative analysis revealed novel methods of olecranon fixation: a modified cable pin system, tension banding through 2 cannulated screws, olecranon memory connector fixation, and cancellous screw TBW. This meta-analysis revealed significantly lower complication and hardware removal rates for PF compared with TBW. Several novel methods of olecranon fixation may represent viable alternatives.