Surgical versus non-surgical management of displaced stable olecranon fractures in older adults: A systematic review and meta-analysis of comparative studies

Bone fragility may modify surgical indications in older adults. This review aimed to compare surgical and non-surgical management in older adults with displaced, stable olecranon fractures, assessing function, complications, and reintervention rates. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. PubMed/MEDLINE, Embase, LILACS, and the Cochrane Library were searched from inception to July 17, 2026, without date or language restrictions. Risk of bias was assessed using Cochrane Risk-of-bias Tool for Randomized Trials and Risk of Bias in Non-randomized Studies of Interventions; mean differences (MDs) and risk ratios (RRs) were calculated using random-effects models, analyzing randomized and observational evidence separately; certainty was rated using Grading of Recommendations Assessment, Development, and Evaluation. Seven comparative studies were included (two randomized trials, five observational studies). In the randomized evidence, surgery showed no significant difference in the disabilities of the arm, shoulder, and hand score at 12 months (MD −6.60; 95% confidence interval [CI] −14.70–1.50; p = 0.110). Complications did not differ significantly in randomized trials (RR = 2.06; 95% CI = 0.37–11.38; p = 0.408) but were more frequent after surgery in the observational sensitivity analysis (RR = 2.57; 95% CI = 1.11–5.94; p = 0.028). Reintervention was more frequent after surgery (RR = 13.56; 95% CI = 1.85–99.46; p = 0.010), consistently across sensitivity analyses. Certainty was low to very low. Surgery did not provide a consistent functional advantage and may be associated with more complications and reinterventions; non-surgical management is a valid option in selected patients, particularly frail older adults or those with low functional demand.