Neer type 2 fractures of the distal third of the clavicle have a non union rate of 22-35% after conservative treatment. Open reduction and internal fixation has been recommended by most authors but there is no consensus about the best method of internal fixation. We retrospectively assessed the union and shoulder function following Hook plate fixation in 18 patients with Neer type 2 fractures of lateral end clavicle with more then a six month follow up after surgery.

There were 14 males with a mean follow-up of 25.89 months (6-48 months) and the average age was 40.33 years (22-62 range). Fifteen had acute fractures and the rest were non unions. Complications included two non unions, one following a deep infection. There were no iatrogenic fractures. Acromial osteolysis was seen in five patients who had their plates in situ. The average pain score at rest was 1 (0-4) and the average pain score on abduction was 2.2 (0-5). The average Constant score was 88.5 (63-100). Patients were asked to rate their shoulder function; three said their shoulder was normal, eleven said it was nearly normal and one rated it as not normal.

Hook plate fixation appears to be a valuable method of stabilising Neer type 2 fractures of the clavicle resulting in high union rates and good shoulder function. These plates need to be removed after union to prevent acromial osteolysis.