Non-operative management is the mainstay of treatment for most fractures of the clavicle in elderly patients. The decision to pursue surgery in the elderly patient is influenced by medical and social factors. Biological and technical factors related to fracture patterns unique to osteoporotic bone are also a consideration. The goals of orthopaedic surgery, which are typically to achieve a united fracture with good alignment, must be balanced with a thorough appreciation of the risks, needs and expectations of the elderly patient with a clavicle fracture.