150 patients with an acute displaced midshaft clavicle fracture were randomized to treatment through either open reduction and internal fixation with a plate or nonoperative management with sling immobilization. Patients were followed-up at 6 weeks, 3 months, 6 months, and 12 months for outcome related to the Disabilities of the Arm, Shoulder, and Hand score, the Constant score, and the incidence of nonunion. Outcome on both the DASH score and the Constant score significantly favoured the plate group compared to the sling group at 6-week and 3-month follow-up, but no significant between-group differences were observed in the measures at 6 months or 12 months. The incidence of nonunion was also significantly lower among the plate group compared to the sling group.