It has been suggested that clavicular midshaft fracture can almont always be treated by conservative methods with a high rate of healing. The most frequent argument against operative treatment of clavicular midshaft fracture is an increased incidence of nonunion after primary open reduction. From 1988 to 1991, twenty eight consecutive patients with moderate to severe angulation and (or) comminution of a fracture in the middle third of the clavicle were treated at our hospital, with pelvic reconstrution plate or intramedullary nailing and supplementary iliac bone graft in each instance. Nearly all fractures were healed without complications such as infection, metal failure, neurovascular compromise and nonunion. Early operative treatment based on our expierience and a review of the literature provides excellent results comparable to the conservative treatment in slected cases. The indications for primary open reduction and internal fixation were; 1) Modrate to severe angulation or comminution of clavicular midshaft fractures. 2) Neurovascular compromise that is progressive or fails to reverse with closed reduction of the fracture. 3) An open fracture that requires operative debridement. 4) Multiple trauma, where patient mobility is desirable and closed methods of immobilization are impractical or impossible.