200 patients with acute displaced midshaft clavicle fractures were randomized either to be treated with open reduction and plate fixation (ORPF) or non-operative treatment to compare the functional outcomes, cost, and non-union rates between the two treatments. After a one year follow-up period the ORPF patients had better DASH and Constant Scores, as well as reduced non-union rates. However, if non-union patients were excluded, the difference between groups in DASH and Constant Scores was no longer statistically significant. Additionally, ORPF was significantly more costly.