Acute sternoclavicular (SC) fracture-dislocations are caused by high-energy trauma, and these injuries are often associated with compression of mediastinal structures. The management of acute SC fracture-dislocations includes closed reduction or open surgical stabilization; however, limited success is reported with closed reduction. Open reduction and suture fixation of acute SC fracture-dislocation allows for anatomic repair of this injury with a good outcomes and low rates of complications. This video highlights the surgical approach, reduction maneuver, and fixation.