72 patients with a displaced midshaft clavicle fracture were randomized to either operative management with plate fixation or nonoperative management with sling immobilization. Patients were assessed for outcomes over the first 6 and 12 months follow-up. For fracture healing, a significantly earlier time to radiographic union was observed with plate fixation versus nonoperative treatment, as well as significantly lower rates of malunion and nonunion. Patient-reported outcome on the Disabilities of the Arm, Shoulder and Hand (DASH) score also significantly favoured the plate fixation group throughout follow-up.