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Unstable distal clavicle fractures may benefit from surgical treatment. This report described a new method with transacromial extra-articular Knowles pin fixation to treat these unstable fractures. The hypothesis is that the results would be improved.Twenty-five patients with unstable distal clavicle fractures were treated by transacromial extra-articular Knowles pin fixation, coracoclavicular ligament repair and augmentation. The mean clinical and radiographic follow-up was 51 months. Functional outcomes were evaluated by a modified Constant-Murley score.Ninety-two percent of patients had uneventful fracture union. Eight percent had delayed or nonunion with pin loosening. Both had successful union after revision surgery. The injured shoulders functioned similar to the uninjured shoulders.The transacromial extra- articular Knowles pin fixation method is a reliable method to treat the unstable distal clavicle fractures with an acceptable complication rate.