Table 1 Order of steps with pitfalls and pearls

Open dissection

Incision needs anterior of the clavicle.

Deltoid splitting is necessary approach and deltoid damage.

Torn intra-articular disk which is not cleared may lead postoperative pain.

A 4-5cm incision allows easy exposure to the AC joint and the clavicle.

Detachment of the a little anterior deltoid allows easy access to the upper surface of the coracoid process.

Exploration of the AC joint is important to remove the torn intra-articular disk and suture.

The AC ligament and AC joint capsule

Guide insertion

It leads injury to the brachial plexus, suprascapular nerves, and blood vessels around the coracoid process if the guard is not corrected.

Coracoid process subperiosteal dissection, the guard is glued to undersurface of the coracoid process and C-arm confirmed.

Clavicular holes

Holes larger than 5 mm may result in a stress fracture of the clavicle.

Holes on the same line leads to nonanatomic fixation.

Improper sites lead to nonanatomic reconstruction.

A small diameter (≤3 mm) of the hole can avoids clavicular fractures.

The clavicular holes: one is proximal hole, slightly posterior on the clavicle which apart 4 cm from the distal end of the clavicle; the other one is distal hole, slightly anterior on the clavicle which apart 2 cm from the distal end of the clavicle.