Fifteen RCTs (n=1343) comparing any form of treatment (operative vs. nonoperative, operative vs. operative, nonoperative vs. nonoperative) in acute displaced midshaft clavicle fractures, were selected for inclusion. The purpose of the study was to evaluate operative and nonoperative interventions in the treatment of acute displaced midshaft clavicle fracture in terms of reoperation, complications, and function after more than 1 year. Nine of the included studies compared operative to nonoperative treatment protocols. Results demonstrated that nonoperative treatment did not increase the risk of reoperation or complications, and operative treatment was slightly favored in terms of functional outcomes. Comparisons between different operative treatments, and different nonoperative protocols, were too limited to comment on.