A 29-year-old male had fallen down while running 1 day ago with complaints of left shoulder pain and activity limitations, and plain AP X-ray confirmed the irregular cortical bone of left distal clavicle (Fig. 15.1), so treated with conservative therapy. After 5 days, he complaining of significantly increasing swelling and pain, with restriction of the left shoulder movement. On physical examination, the patient had a tender left shoulder with superficial ecchymoses and positive piano key sign. Three-dimensional CT reconstruction revealed a superiorly displacement of the proximal of distal clavicle fracture, so the surgical treatment was chosen (Fig. 15.2).