Rope Traction Techniques in the Management of Humeral Shaft Fractures: A Systematic Review and Meta-Analysis of Functional and Radiological Outcomes

Rope traction remains a traditional conservative method for managing humeral shaft fractures. However, comprehensive evidence regarding its functional and radiological efficacy compared with modern methods is limited. To evaluate the functional and radiological outcomes of rope traction techniques in humeral shaft fractures, a systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Databases (PubMed, Embase, Scopus, Cochrane Library) were searched up to October 2025 for studies reporting outcomes of rope traction or hanging arm cast in adults. Pooled union rates were calculated using a random-effects model with 95% confidence intervals (CIs). Five studies (n = 469) were included. The pooled union rate was 94.5% (95% CI: 91.3-97.1%) with low-to-moderate heterogeneity (Q = 7.42, p = 0.19, I² = 32%). Over 80% of patients achieved a full or near-full range of motion, and radiographs showed early callus formation, preserved alignment, and negligible malunion. Rope traction techniques achieve high union rates and excellent functional recovery, representing a safe, cost-effective alternative for patients where surgical fixation is contraindicated or unavailable.