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BACKGROUND The purpose of this study is to determine the efficacy of operative management for the treatment of patients with an extra-lateral distal clavicle fracture pattern. This fracture pattern is not currently included in the modified Neer classification. METHODS We retrospectively reviewed 48 patients who underwent open reduction and internal fixation of an acute extra-lateral distal clavicle fracture pattern between August 2005 and March 2019. Postoperative clinical outcomes were time to union, active shoulder range of motion, scar size, patient sensation of a "normal" shoulder and Disabilities of the Arm, Shoulder and Hand scores. RESULTS Postoperatively, all patients achieved union at an average of 7.9 weeks (range, 4-20 weeks), all patients re-gained full active shoulder range of motion at an average of 10.1 weeks (range, 5-44 weeks), had a scar size of 3-4cm and 93.8% of patients reported that their shoulder felt "normal" again following union. Disabilities of the Arm, Shoulder and Hand score was 1.7 (range, 0-28) at 12-months postoperatively. CONCLUSION Patients had very good clinical outcomes following operative management of an extra-lateral distal clavicle fracture pattern. We recommend that this fracture pattern be added to the current modified Neer classification as a type IIC fracture. LEVEL OF EVIDENCE Level IV; Case Series; Treatment Study.