Abstract:[Objective] To compare the clinical efficacy of Tightrope combined with percutaneous screw (TRPS) versus clavicular hook plate (HP) for Cho's type IIC distal clavicular fracture in the elderly. [Methods] A retrospective study was conducted on 63 elderly who had Cho's IIC distal clavicle fractures treated surgically in our department from January 2015 to January 2023. According to the doctor-patient communication, 31 patients were treated with TRPS, while other 32 patients received HP. The perioperative, follow-up and imaging data of the two groups were compared. [Results] The TRPS group proved significantly superior to the HP group in terms of operation time [(65.8± 16.7 min) vs (83.1±20.8) min, P 0.001], incision length [(1.9±0.7) cm vs (9.5±1.9) cm, P 0.001], intraoperative blood loss [(21.5±9.9) mL vs (97.5±55.8) mL, P 0.001], and hospital stay [(8.4±2.2) days vs (13.3±5.6) days, P 0.001]. All patients in both groups were followed for more than 12 months. As time went on, the VAS score, Constant-Murley score, forward elevation range of motion (ROM) and abduction elevation ROM were significantly improved in both groups (P＜0.05). The TRPS group was significantly better than the HP group in terms VAS score [(1.7±0.6) vs (2.6±1.1), P 0.001; (0.6±0.5) vs (1.5±0.9), P 0.001], Constant-Murley score [(85.0±4.0) vs (80.0±4.6), P＜0.001; (91.9±3.9) vs (88.5±4.8), P 0.001] and forward elevation ROM [(127.3±11.1)° vs (118.2±14.7)°, distal clavicular fracture, Tightrope, percutaneous screw, hook plate, acromioclavicular joint=0.008; (155.3±10.9)° vs (144.7±13.5)°, P 0.001], abduction elevation ROM [(116.5±10.0)° vs (108.1±12.9)°, P 0.001; (148.9±13.0)° vs (127.7±17.9)°, P 0.001] 3 months postoperatively and the latest follow-up. As for imaging. there was no significant difference in fracture reduction quality between the two groups (P＞0.05). The coracoclavicular distance (CC) was significantly decreased in both group after operation compared with that preoperatively (P＜0.05), whereas which was not statistically significant between the two groups at any corresponding time points (P＞0.05). [Conclusion] Both surgical techniques for the treatment of senile osteoporotic Cho's type IIC distal clavicle fracture have obtained good clinical consequence. However, the Tightrope combined with percutaneous screw takes advantages of small incision and less trauma, relieving early postoperative pain and facilitating the functional recovery over the hook plate.