Modern fixation techniques versus traditional tension band wiring for olecranon fractures: a systematic review and meta-analysis of functional outcomes, healing time, and complications.

BACKGROUND

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.

METHODS

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.

RESULTS

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 < 0.001). The Cable-pin System appeared to achieve the fastest healing time (8.90 weeks; 95% CI [7.53, 10.27]), significantly shorter than traditional TBW (12.60 weeks; 95% CI [12.08, 13.12]). Modern techniques appeared to show substantially lower complication rates (RR = 0.11; 95% CI [0.00, 0.34]; p < 0.001), particularly in hardware-related complications. Temporal analysis indicated that risk reduction with modern techniques increases progressively during follow-up, with 24-month hardware-related complication-free survival of 94.2% for the Cable-pin System versus 58.4% for traditional TBW. Patient age emerged as a significant predictor of postoperative complications, with each additional year increasing complication risk by 1.19%.

CONCLUSIONS

Modern fixation techniques may offer superior functional outcomes, faster healing, and fewer complications than traditional tension band wiring for olecranon fractures. Cable-pin System appears optimal for simple fractures, while Eyelet K-wire System shows advantages for comminuted fractures. However, substantial heterogeneity (I > 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.