HOOK PLATE VS. LATERAL LOCKING PLATE FOR LATERAL FRACTURE
Moderate evidence demonstrates that lateral locking plates may have fewer complications and better functional outcomes than hook plates for the treatment of lateral (Neer Type II) clavicle fractures in adults.

Rationale

One randomized comparative trial (Wang 2020) evaluated the outcomes and complications following operative management of Neer Type II distal clavicle fractures treated with Hook plate versus Lateral Locking plate. Another study found no differences in objective outcomes of healing time, operative time, or blood loss between techniques but lower post-operative complication rates in the locking plate group (OR 5.64, 95% CI 1.37, 23.19) (Wang et al.). Additionally, subjective pain and outcomes scores (Constant, and UCLA) were significantly better in the locking plate techniques compared to the hook plate.

Benefits/Harms of Implementation

The choice of surgical plating technique for Neer Type II distal clavicle fractures appears to demonstrate a benefit with the use of lateral locking plates. A reduction in complications was demonstrated while providing similar rates of bony healing, comparable surgical time, and better patient reported outcomes.

Outcome Importance

Understanding the potential advantages and disadvantages of different surgical techniques for this potentially difficult surgical problem can improve complication rates and patient reported outcomes.

Cost Effectiveness/Resource Utilization

Based on the current evidence there is no recommendation that can be made related to cost/resource effectiveness on this topic. Given a substantial difference in complications between the two techniques the opportunity for cost analysis may be helpful to further analyze the global utility of each treatment.

Acceptability

The use of lateral locking plates requires minimal change to clinical practice as these are common plating techniques used throughout the body. Thus, the findings of this recommendation are likely to be acceptable amongst treating surgeons.

Feasibility

The surgical technique of lateral locked plating requires minimal if any major change in the surgical approach and definitive treatment technique and thus is feasible in most situations. The availability of lateral locking plates may be the only significant deterrent to the feasibility of this recommendation.

Future Research

Additional research is needed on this topic to further support or refute the findings of this study and to evaluate the cost effectiveness and ideal populations for the proposed techniques.