All patients underwent surgery placed in a beachchair position with the affected arm in a mobile position. A longitudinal skin incision was set below the clavicle with subsequent incision through the clavi-pectoral fascia also in longitudinal direction to allow for a later closure to ensure sufficient soft tissue coverage. After exposure of the non- or malunion a complex multidimensional osteotomy of the clavicle with medial and lateral axial correction up to vital bone was performed. Vital bone was verified by local blood extravasation resulting from drilling the previously osteotomized bone segments. The tricortical iliac crest bone graft was harvested according to the size assessed in the preoperative CT scan, consecutively adapted to the intraoperative measured size of the bony defect. After implantation of the bone graft the LCP was centered onto the clavicular shaft. At least three screws should be placed medially and laterally to the bone graft to ensure sufficient biomechanical stability. Before drilling the screw holes the plate position was controlled by fluoroscopy. If necessary the iliac crest bone graft should additionally be fixed by a suture cerclage (Fiber- Wire, Arthrex). After a final radiographical examination the wound was closed layer by layer.