BACKGROUND There is controversy about the optimal strategy treatment of unstable distal clavicle fractures. We explored use of a surgical strategy: combination of a distal clavicle locking plate and a titanium cable. The purpose of this retrospective case series study was to evaluate the clinical outcomes of this new strategy in treating Neer type II distal clavicle fractures. METHODS Twenty-one patients with Neer type II distal clavicle fracture were treated with a distal clavicle locking plate and a titanium cable. All patients were followed for at least one year. We retrospectively collected and reviewed follow-up data. The clinical outcomes were assessed for union rate, functional score, and complication rate. RESULTS All patients achieved bony union within 6 months. The average follow-up period was 20.6 months (range12-48 months). The mean Constant score at one-year follow-up was 94.6 ± 3.3 (range 84-98), and the mean UCLA (University of California, Los Angeles) score was 33.3 ± 2.6 (range 27-35). Only one complication (wound infection) was observed during follow-up. Two patients received another operation for implant removal due to local irritation. CONCLUSIONS Use of a distal clavicle locking plate in combination with a titanium cable for treatment of Neer type II fractures results in high union rate, a low complication rate, and good shoulder function. This combined surgical strategy can be considered an effective method for treating unstable distal clavicle fractures.