45 patients with closed displaced midshaft fractures were randomized to receive either intramedullary pin fixation or minimally invasive locking-plate fixation. This study aimed to compare the efficacy of both techniques and considered their impacts on functional status, pain, cosmetic appearance, and time to bony union. Outcomes were assessed by the Quick DASH questionnaire and radiographic evaluations every 3 months following surgery, for up to 38 months. The results of this study indicated that the use of intramedullary pinning offered more rapid union of the bone and a lower rate aesthetic dissatisfaction. However, no significant difference in the incidence of complications, pain, or functional status was noted.