Management of type II distal clavicle fractures has always been a challenge. Non-operative treatment has a high risk of complications and should be considered only for elderly and frail patients. For younger and active patients there is a wide variety of operative options, each with advantages and disadvantages. According to our unit's experience the first choice could be hook plate fixation, with very good and reproducible results. Another option could be Kirschner-wire fixation with or without tension band wiring; however, because of potential wire complications or difficulties in rehabilitation, the method should be reserved for reliable patients and used with a meticulous technique.