57 patients with a displaced fracture of the distal third of the clavicle were randomized to treatment through either open reduction and internal fixation with a plate, or to conservative management through sling immobilization. Follow-up was performed at 1 year after treatment. Patient-reported disability and function scores demonstrated no significant differences between groups. Malunion and nonunion rates were significantly greater in the conservative treatment group compared to the ORIF group, but subsequent surgery rate did not significantly differ between groups.