69 patients with a closed, displaced clavicle fractures (Robinson type 2B) were randomized to surgery with open reduction and internal fixation with a plate, or to nonoperative treatment with an arm pouch sling. Patients were followed over 24-months of follow-up for union, incidences of nonunion and malunion, complications, and function through the Constant score. Results demonstrated no significant differences in the rate of nonunion between groups, though time to union was significantly shorter in the plate group compared to sling group. Additionally, function at 24 months was significantly greater in the plate group compared to the sling group.