title: Efficacy and safety of tension band wiring versus plate fixation in olecranon fractures: a systematic review and meta-analysis.
abstract: BACKGROUND
  Olecranon fracture (OF) is a common upper limb fracture, and the most commonly used techniques are still tension band wiring (TBW) and plate fixation (PF). The aim of the current study is to discuss whether TBW or PF technique of internal fixation is better in the treatment of OFs, using the method of meta-analysis.
  
  
  METHODS
  The eligible studies were acquired from PubMed, CNKI, Embase, Cochrane Library, and other sources. The data were extracted by two of the coauthors independently and were analyzed by RevMan5.3. Standardized mean differences (SMDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa Scale were used to assess risk of bias.
  
  
  RESULTS
  Thirteen studies including 1 RCT and 12 observational studies were assessed. Our meta-analysis results showed that both in RCT and observational studies, there were no significant differences between the two groups in disabilities of the arm, shoulder and hand (DASH) (SMD = 0.07, 95% CI = -0.32 to 0.46, p = 0.73), improvement rate (OR = 0.76, 95% CI = 0.48-1.22, p = 0.26), range of motion (ROM), operation time (SMD = -0.51, 95% CI = -1.17 to 0.14, p = 0.12) and blood loss (SMD = -0.97, 95% CI = -2.06 to 0.11, p = 0.08). The overall estimate of complications indicated that the pooled OR was 2.61 (95% CI = 1.65-4.14, p < 0.0001), suggesting that the difference was statistically significant. We also compared the outcomes of patients with mayo type IIA OFs treated by TBW and PF in DASH and ROM and found no differences.
  
  
  CONCLUSIONS
  Both TBW and PF interventions had treatment benefit in OFs. The current study reveals that there are no significant differences in DASH, improvement rate, ROM, operation time, and blood loss between TBW and PF for OFs. Due to the less complications, we recommend the PF approach as the optical choice for OFs. More high-quality studies are required to further confirm our results.
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Anshan Road 154, Tianjin, 300052, People's Republic of China.
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Ren
authors.affiliation: Department of Orthopedics, Shanxi Medical University Second Affiliated Hospital, Shanxi, People's Republic of China.
authors.forename: Hu-Yun
authors.initials: HY
authors.lastname: Qiao
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Anshan Road 154, Tianjin, 300052, People's Republic of China.
authors.forename: Zhi-Jian
authors.initials: ZJ
authors.lastname: Wei
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Anshan Road 154, Tianjin, 300052, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Lin
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Anshan Road 154, Tianjin, 300052, People's Republic of China.
authors.forename: Bao-You
authors.initials: BY
authors.lastname: Fan
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Anshan Road 154, Tianjin, 300052, People's Republic of China.
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Anshan Road 154, Tianjin, 300052, People's Republic of China.
authors.forename: Ang
authors.initials: A
authors.lastname: Li
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Anshan Road 154, Tianjin, 300052, People's Republic of China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Kang
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Anshan Road 154, Tianjin, 300052, People's Republic of China.
authors.forename: Shen
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Anshan Road 154, Tianjin, 300052, People's Republic of China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Hao
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Anshan Road 154, Tianjin, 300052, People's Republic of China. zhouxh007@126.com.
authors.forename: Xian-Hu
authors.initials: XH
authors.lastname: Zhou
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Anshan Road 154, Tianjin, 300052, People's Republic of China. sqfeng@tmu.edu.cn.
authors.forename: Shi-Qing
authors.initials: SQ
authors.lastname: Feng
mesh_terms: D001860:Bone Plates / Q000009:adverse effects; D001864:Bone Wires / Q000009:adverse effects; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D064887:Observational Studies as Topic / Q000379:methods; D056740:Olecranon Process / Q000293:injuries* / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*
keywords: Meta-analysis; Olecranon fracture; Plate fixation; Systematic review; Tension band wiring