Metalwork Prominence and Operative Interventions for Treating Olecranon Fractures: Systematic Review of Randomised...

In this systematic review of randomized controlled trials, we aimed to assess the effects of different surgical treatments for olecranon fractures in adults, especially the rate of metalwork prominence. We searched the Cochrane Bone, Joint, and Muscle Trauma Group's Specialized Register (2018), the Cochrane Central Register of Controlled Trials (CENTRAL, 2018, Issue 1), Ovid MEDLINE (1946-2018), and Embase (1980-2018). We also searched ISRCTN registry, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry platform for ongoing and recently completed trials (2018). Data were extracted using a pretested form. Risk of bias was assessed using the Cochrane Collaboration's risk of bias tool. For binary outcomes, we expressed the treatment effects as risk ratios with 95% confidence intervals; for continuous outcomes, we expressed treatment effects as mean differences. We included eight trials involving 399 patients (220 men and 179 women); there were six RCTs and two quasi-RCTs. In seven trials, standard-tension band-wiring technique (TBW) was the control group. We compared it against the modified plate fixation or modified techniques of TBW. For trials comparing TBW versus modified-TBW (five trials), similar outcomes were reported, but with a higher rate of metalwork prominence with standard TBW. Two trials compared plate fixation with TBW and reported higher metalwork prominence with TBW but more serious complications with plate fixation. One trial compared locking plate with memory connector plate fixation with no significant differences. Tension band wiring remains the gold standard technique for olecranon fractures with high rate of symptomatic metalwork prominence.