Olecranon fractures represent a significant challenge in orthopedic trauma, and multiple surgical fixation techniques are available. While tension band wiring (TBW) has been the traditional standard, modern techniques have emerged, including Cable-pin Systems, plate fixation, and novel approaches. This systematic review and meta-analysis evaluates the comparative effectiveness of these fixation methods in terms of functional outcomes, healing time, and complications. A comprehensive systematic search was conducted across PubMed, Embase, Cochrane Library, and Web of Science databases from January 2013 to February 2025. We included randomized controlled trials and comparative cohort studies evaluating surgical fixation techniques for adult olecranon fractures. Primary outcomes included the Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, range of motion, fracture healing time, and complications. Meta-analyses were performed using random-effects models, with pre-specified subgroup analyses based on fixation techniques and patient characteristics. Nine studies involving 472 patients met the inclusion criteria. Modern fixation techniques demonstrated superior functional outcomes compared to traditional TBW, with the Cable-pin System showing significantly higher MEPS scores (mean difference = 13.03 points; 95% CI 10.89, 15.17; p 70%) limits the certainty of findings. Treatment selection should consider patient age, bone quality, and fracture complexity. Larger standardized trials are needed to confirm these preliminary conclusions and refine evidence-based treatment algorithms.
Wang et al. (Sat,) studied this question.