Abstract:[Objective] To compare the clinical efficacy of Tight-rope combined with Nice knot reinforcement versus anatomical lock- ing plate in the treatment of Neer type IIb distal clavicular fractures. [Methods] A retrospective study was performed on 58 patients who re- ceived surgical treatment for Neer type IIb distal clavicular fractures in our department from January 2017 to December 2020. According to the results of doctor-patient communication, 27 patients underwent Tight-rope combined with Nice knot (TR group), while the other 31 pa- tients received anatomic locking plate for fixation of the distal clavicular fracture (plate group). The perioperative, follow-up and imaging data were compared between the two groups. [Results] The TR group proved significantly superior to the plate group in terms of operation time [(71.4±31.8) min vs (85.2±27.0) min, P＜0.05], the total length of incision [(3.6±1.3) cm vs (10.1±2.0) cm, P＜0.05], intraoperative bleeding [(24.4±19.4) ml vs (96.7±43.3) ml, P＜0.05], hospital stay [(10.8±3.7) days vs (13.4±5.5) days, P＜0.05] and time to return active ac- tivity [(28.5±4.2) days vs (34.5±3.9) days, P＜0.05]. All of them in both groups were followed up for more than 24 months, and TR group re- sumed full weight-bearing activity significantly earlier than the plate group [(19.0±1.5) weeks vs (21.3±2.5) weeks, P＜0.05]. The ConstantMurley scores, abduction-lifting, forward flexion upward lifting, and internal-external rotation range of motion (ROM) of the shoulder in- creased significantly over time in both groups (P＜0.05). Although there was no significant difference in the above items between the two groups before surgery (P＞0.05), the TR group proved significantly superior to the plate group in terms of Constant-Murley score [(80.7±4.4) vs (78.3±4.5), P＜0.05], abduction-lifting ROM [(121.9±9.0)° vs (112.7±8.4)°, P＜0.05], forward flexion upward lifting ROM [(128.5±6.8)° vs (119.4± 8.0)°, P＜0.05] and the internal-external rotation ROM [(115.9±5.5)° vs (112.1± 5.7)°, P＜0.05] 3 months postoperatively. Radio-graphically, the TR group was significantly better than the plate group in fracture reduction quality [excellent/good/poor, (21/7/0) vs (1/17/ 2), P＜0.05] and postoperative coracoclavicular distance (CCD) at the last follow-up [(9.4±1.8) mm vs (11.9±1.4) mm, P＜0.05], regardless of that there was no significant difference in fracture healing time between the two groups (P＞0.05). [Conclusion] Both surgical methods have obtained good clinical efficacy in the treatment of Neer type IIb distal clavicular fractures, while Tight-rope combined with Nice knot rein- forcement takes less trauma, and better pain relief and shoulder function over the plate fixation.