Operative management of clavicle fractures is considered when the break is significantly displaced, shortened, involves skin tenting or open injury, or when there is risk of damage to nearby nerves or blood vessels. Surgery is also more often recommended in athletes or individuals who need a faster and more reliable return to full shoulder function.

The most common procedure is open reduction and internal fixation (ORIF), where the bone is realigned and stabilized with plates and screws or sometimes an intramedullary rod/pin. Surgery helps restore the normal length and alignment of the collarbone, which can reduce the risk of malunion, nonunion, or shoulder weakness. Postoperatively, patients usually wear a sling briefly, followed by a guided rehabilitation program to regain strength and motion.