Six randomized controlled trials were included in this meta-analysis that compared the use of open reduction and plate fixation to nonoperative management for displaced midshaft clavicle fractures. The results of the pooled analyses indicated that the rate of nonunion was significantly lower in patients treated operatively. While the rate of secondary procedures for complications was lower in the operative group, when hardware removals were included in the rate of secondary procedures they were similar between groups. Functional outcome scores favoured the operative group, but these differences were deemed not clinically relevant.