OBJECTIVE This retrospective study aimed to compare the fracture union and functional results of clavicular hook plate fixation versus arthroscopy-assisted TightRope fixation of unstable fractures of the distal clavicle. METHODS Forty patients with unstable (Neer II) distal clavicular fracture were treated surgically using either a clavicular hook plate (n=19) or arthroscopy-assisted TightRope fixation (n=21) between 2007 and 2012 in our hospital. Medical records were retrospectively reviewed. Clinical and radiological results after an average period of 62 months for the clavicular hook plate and 32 months for TightRope were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) score, the Constant score, and the RAND 36-item health questionnaire. RESULTS One fracture in each group was failed to unite. The mean Constant score was 93 in the TightRope group and 89 in the clavicular hook plate group, with mean DASH scores of 6 and 11, respectively. According to data from the RAND 36-item questionnaire, health-related quality of life returned to normal in both groups. Removal of the plate was the main reason for reoperation. CONCLUSIONS TightRope and clavicular hook plate repairs of unstable distal clavicular fractures result in similar fracture union and good clinical outcomes.