Locking Plates for Extremity Fractures

Jeffrey Anglen, MD, Richard F. Kyle, MD, John Lawrence Marsh, MD, Walter W. Virkus, MD, William C. Watters, III, MD, Michael Warren Keith, MD, Charles M. Turkelson, PhD, Janet L. Wies, MPH and Kevin M. Boyer J Am Acad Orthop Surg, Vol 17, No 7, July 2009,

The Technology Overview was prepared by an AAOS physician task force using systematic review methodology and summarizes the findings of studies published as of April 1, 2008, on locking plates for extremity fractures. As a summary, this document does not make recommendations for or against the use of locking plates for extremity fractures. It should not be construed as an official position of the American Academy of Orthopaedic Surgeons. Readers are encouraged to consider the information presented in this document and reach their own conclusions about locking plates for extremity fractures. The Technology Overview was adopted by the Board of Directors of the American Academy of Orthopaedic Surgeons on December 6, 2008. The American Academy of Orthopaedic Surgeons has developed and is providing the Technology Overview as an educational tool. Patient care and treatment should always be based on a clinician’s independent medical judgment given the individual patient’s clinical circumstances. Thirty-three peer-reviewed studies met the inclusion criteria for the Overview. Criteria were framed by three key questions regarding indications for the use of locking plates, their effectiveness in comparison with traditional nonlocking plates, and their cost-effectiveness. The studies were divided into seven applications: distal radius, proximal humerus, distal femur, periprosthetic femur, tibial plateau (AO/OTA type C), proximal tibia (AO/OTA type A or C), and distal tibia. Patient enrollment criteria were recorded to determine indications for use of locking plates, but the published studies do not consistently report the same enrollment criteria. Regarding effectiveness, there were no statistically significant differences between locking plates and nonlocking plates for patient-oriented outcomes, adverse events, or complications. The literature search did not identify any peer-reviewed studies that address the cost-effectiveness or cost-utility of locking plates.