Although there is a paucity of published information on relevant clinical outcomes, locking plates have become widely accepted. Anatomically pre-shaped locking plates allow for fixation at several different anatomic sites and are therefore widely adaptable. The use of new techniques such as subchondral support locking pins, multiaxial pads, and locking washers have further improved intraoperative flexibility. However, there is insufficient information on the effectiveness of these new techniques. The clinical efficacy of locking plates is generally good, but there are inherent complications, such as difficult removal of the internal fixation, misalignment, fragmentation of the fracture fragment, and poor fixation of the diaphysis, especially with pre-shaped locking plates and single cortical screws. The high cost of locking plates is also an issue, with this technique costing more than three times as much as comparable non-locking plates. Locking plates should be used in patients with refractory fractures that are not well treated with non-locking plates. Although a large number of locking plates are anatomically designed specifically for extra-articular fractures, such as distal femur, proximal tibia, proximal humerus, and distal radius fractures, there is a need for a family of plates that can be used to fix smaller or larger fracture fragments. The indications for these plates are not yet known. Fractures that have been successfully treated with conventional plates (e.g., humeral stem, forearm double fractures, ankle fractures) that require locking fixation include patients with severe osteoporosis, segmental bone loss, and shortened limbs due to fracture comminution. The cost of locking plates is higher than non-locking plates. Locking plates are expensive not because of the plates but because of the locking screws. Most plates are now available with the surgeon’s choice of locking or non-locking screws in the same hole, so the choice of different screws should be worth considering. Conventional screws usually apply pressure to the fracture and bring the plate closer to the bone, facilitating repositioning. Locking screws can be used to enhance stability. This hybrid technique of locking and non-locking screws cannot be used with first-generation locking plates, which may explain why reliable compression and adjustment of the fracture and plate to the proper position relative to the diaphysis is not possible with first-generation locking plates. In the last 10 years, locking implants for complex fractures have been improved and their clinical superiority and indications have been rapidly accepted by clinicians. The theoretical superiority of the stability enhancement provided by locking plates and the biological superiority provided by the technique of non-invasive insertion with muscle has been generally proven and has improved bone healing rates. Misalignment, bone discontinuity, implant failure, fractures and steep learning curves (poor learning) remain current challenges, and most recent data suggest that operation by a skilled practitioner with advanced equipment reduces the incidence of complications. Future developments in instrumentation are directed toward improving subchondral support, increasing screw angulation capacity and locking stability, and designing more specialized devices to facilitate fracture reduction. In general, locking devices should be considered in osteoporotic patients and in fractures that are prone to failure with conventional plate therapy, especially comminuted metaphyseal fractures. Early data show the benefits of multiaxial bone pins as well as multiple anatomically shaped plates, but further clinical data studies are needed to determine if these techniques are truly effective.