Fourteen randomized controlled trials including 979 patients with displaced midshaft clavicle fractures were included in this systematic review and meta-analysis comparing intramedullary fixation versus plate fixation. Pooled outcomes of interest included Disabilities of Arm, Shoulder and Hand Score (DASH Score), Constant Murley Score (CM Score), hospitalization time, operation time, incision size, infection, non-union, reintervention or revision, refracture, irritation and pain, and cosmetic dissatisfaction. The results indicated no significant difference in DASH and CM scores between the two groups. However, intramedullary fixation showed significantly lower hospitalization time, operation time, incision size, infection rates, reintervention or revision rates, irritation and pain, and cosmetic dissatisfaction compared to plate fixation. These findings suggest that intramedullary fixation may be a preferred option due to its associated lower complication rates and better cosmetic outcomes.