Introduction: Fractures of the clavicle constitute 2.6% of all fractures, account for 44% of the injuries around the shoulder girdle, approximately 70-80% of which occur in the middle third. Even when significantly displaced traditionally these fractures are treated without surgery. Conservative treatments either by sling/figure of 8 bandage/clavicular brace is favored by patients, but the results are much inferior to what reported previously. Present study conducted to operate fresh fracture with displacement >2cm, non-union by ORIF with locking plate with or without bone grafting. Objective is relief from pain, restoration of activities as far as possible & better cosmetic appearance. Material & methods: 28 cases of clavicle in healthy active individuals between 16-65 yrs. of age operated between Dec. 2012 to September 2016 in Hi-Tech Medical College, Rourkela, Odisha. Fracture classified by Allman in to three groups as middle 1/3rd, distal 1/3rd, medial 1/3rd. Indications for surgery either opens, vascular injuries, initial displacement >2cm, nonunion, cosmetically conscious patients. Results: 15 cases of fresh, 6 cases of symptomatic delayed union and 7 cases of nonunion operated with precontoured plate with or without bone grafting. The average hospital stay was 3-7 days. The average time of fracture union was 10 weeks (8-12 weeks). Patients were followed weekly up to 4 weeks and then after 2 and 6 months. The functional outcome according to Constant and Murley score is excellent in 17 patients (60.7%), good in 10 patients (35.7%) and satisfactory in 01 case (3.6%). There was no major complication, 1 patient had superficial infection, deep infection in 1 case, nonunion in 1 case and plate breakage in 1 patient. Results were compared with cases treated conservatively. 

Conclusion: In present era of competition, cosmesis and advancement with least morbidity & excellent results is required. ORIF in selected cases is a very good option in comparison to accept morbidity, cosmetic disfigurement and below average functional results. 

Keywords: Osteosynthesis; Symptomatic; Non-Union; Fracture; Clavicle.