Fifty-seven patients with displaced type II distal clavicle fractures were randomized to receive either operative treatment (n=27) or non-operative treatment (n=30). The primary outcome of interest was the Disabilities of the Arm, Shoulder, and Hand (DASH) score at two years. Secondary outcomes included union rates, re-operation rates, satisfaction with shoulder appearance, and return to activities. Outcomes were assessed at one and two years. Overall, the results revealed no significant difference in DASH scores between the two groups at two years, indicating excellent function in both groups. However, 48% of the operative group required hardware removal, while 20% of the non-operative group required surgical intervention due to non-union. Union rates were comparable at two years. These findings suggest that while both treatment approaches yield similar long-term functional outcomes, operative treatment carries a higher risk of hardware-related complications, while non-operative treatment is associated with a higher risk of non-union requiring late surgical intervention.