Interventions for treating olecranon fractures in adults: Protocol for a systematic review and meta-analysis of randomized controlled trials (Preprint)

<sec> <title>BACKGROUND</title> Olecranon fractures are prevalent elbow injuries in adults, often necessitating surgical intervention. While the tension band wiring technique is widely employed, it is associated with a high rate of complications. The current body of evidence includes a significant number of new studies published since the last comprehensive Cochrane review in 2014, highlighting a critical need for an updated and thorough synthesis of evidence to compare the effectiveness and safety of available treatment options. </sec> <sec> <title>OBJECTIVE</title> This systematic review aims to identify, evaluate, and compare the effectiveness of different treatment options, including conservative and surgical approaches, for adult olecranon fractures, focusing on reducing complications, improving functional outcomes, and patient satisfaction. </sec> <sec> <title>METHODS</title> This systematic review and meta-analysis protocol is designed according to the Cochrane Handbook for Systematic Reviews of Interventions and will be reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement. The final systematic review results will be reported according to the PRISMA 2020 guidelines. We will include randomized controlled trials (RCTs) evaluating any type of treatment for acute olecranon fractures in adults. Comprehensive searches will be conducted in major electronic databases, including PubMed, the Cochrane Library, EMBASE, LILACS, and SciELO, up to December 2025. Two independent reviewers will screen studies for eligibility, extract data using a pre-piloted, standardized form, and assess the risk of bias using the Risk of Bias 2 (RoB 2) tool. Primary outcomes will include functional assessment scores (e.g., MEPS, DASH) and adverse events (e.g., reoperation, infection, implant prominence). Secondary outcomes will encompass range of motion, pain, patient satisfaction, radiographic healing, and economic outcomes. A random-effects model will be used for meta-analysis when appropriate, with heterogeneity assessed by I². Subgroup and sensitivity analyses will explore factors such as age, fracture classification, and type of intervention. The certainty of evidence will be assessed using the GRADE approach. </sec> <sec> <title>RESULTS</title> As of September 2025, preliminary searches and selection of articles have been conducted. However, comprehensive database searches are planned to be repeated and finalized by December 2025 to ensure the inclusion of the most recent studies. The full systematic review is projected to be completed by July 29, 2026 </sec> <sec> <title>CONCLUSIONS</title> This systematic review will provide a robust synthesis of the current evidence on treatments for adult olecranon fractures. The findings are expected to clarify the comparative effectiveness and safety of various interventions, thereby informing clinical practice, guiding shared decision-making between patients and clinicians, and identifying key areas for future research and randomized controlled trials. </sec> <sec> <title>CLINICALTRIAL</title> PROSPERO CRD42024520697 </sec>