160 patients with a displaced, midshaft clavicle fracture were randomized to be treated with either open reduction and internal plate fixation or with sling immobilization. Reported outcome included nonunion rate (primary), functional measures (Constant and Disability of the Arm, Shoulder, and Hand [DASH] scores), and the incidence of secondary surgery. The ORIF group demonstrated a significantly lower rate of nonunion after both index intervention, as well as after secondary plate fixation when compared to the nonoperative group. No significant differences were reported between groups for either the Constant score or the DASH score.