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Locking Plates for Extremity Fractures

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.

Dr. Anglen is Professor and Chairman, Department of Orthopaedic Surgery, Indiana University Medical Center, Indianapolis, IN. Dr. Kyle is Chair, Department of Orthopaedic Surgery, Hennepin County Medical Center, Minneapolis, MN. Dr. Marsh is Professor, Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA. Dr. Virkus is Orthopaedic Surgeon, Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, IL. Dr. Watters is Orthopaedic Surgeon, Bone and Joint Clinic of Houston, Houston, TX. Dr. Keith is Professor, Orthopaedics and Biomedical Engineering, and Chief, Hand Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH. Dr. Turkelson is Director, Department of Research and Scientific Affairs, American Academy of Orthopaedic Surgeons, Rosemont, IL. Ms. Wies is Manager, Clinical Practice Guidelines Unit, Department of Research and Scientific Affairs, American Academy of Orthopaedic Surgeons. Mr. Boyer is Research Analyst, Guidelines, Department of Research and Scientific Affairs, American Academy of Orthopaedic Surgeons.

Dr. Anglen or a member of his immediate family serves as a board member, owner, officer, or committee member of American Board of Orthopaedic Surgery, American College of Surgeons, and Orthopaedic Trauma Association; is affiliated with the publications Journal of the American Academy of Orthopaedic Surgeons and Journal of Orthopaedic Trauma; has received royalties from Biomet; serves as a paid consultant to or is an employee of Stryker; has received research or institutional support from Stryker and Wyeth; and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from the Journal of the American Academy of Orthopaedic Surgeons. Dr. Kyle or a member of his immediate family serves as a board member, owner, officer, or committee member of Twin Cities Orthopaedic Education Association, Minneapolis Medical Research Foundation, Midwest Orthopaedic Research Foundation, Hennepin Faculty Associates, and Millennium Medical Technologies; is affiliated with the publication Journal of Shoulder and Elbow Surgery; has received royalties from DePuy, Encore Medical, Smith & Nephew, and Zimmer; and has received research or institutional support from DePuy. Dr. Marsh or a member of his immediate family serves as a board member, owner, officer, or committee member of Orthopaedic Trauma Association; has received royalties from Biomet; has received research or institutional support from Smith & Nephew; and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from Oxford University Press and Smith & Nephew. Dr. Virkus or a member of his immediate family serves as a paid consultant to or is an employee of Stryker; has received research or institutional support from Stryker; has stock or stock options held in Stryker; and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from Stryker. Dr. Watters or a member of his immediate family serves as a board member, owner, officer, or committee member of Bone and Joint Decade, USA, North American Spine Society, Intrinsic Therapeutics, Work Loss Data Institute, and American Board of Spine Surgery; is affiliated with the publication The Spine Journal; serves as a paid consultant to or is an employee of Blackstone Medical, Medtronic Sofamor Danek, Stryker, Intrinsic Therapeutics, and McKessen Health Care Solutions; and has stock or stock options held in Intrinsic Therapeutics. Ms. Wies or a member of her immediate family has stock or stock options held in Shering Plough. None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Keith, Dr. Turkelson, and Mr. Boyer.

Evidence tables displaying the raw data and information extracted for the Technology Overview are available in a supplemental document available on the AAOS Website, www.aaos.org/technologyoverviews.

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.