A total of 10 randomized controlled trials with 641 patients with midshaft clavicle fractures (MSCF) were included in this meta-analysis comparing plate fixation (n=322) and intramedullary fixation (IMF) (n=319). The primary outcome of interest was long-term shoulder function, measured with the Constant-Murley Shoulder Outcome questionnaire and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Secondary outcomes of interest included treatment failure and the incidence of complications not requiring non-routine surgery. Additional outcomes included the incidence of infections, nerve injury-associated complications, implant-associated complications, and cosmetic dissatisfaction. Pooled results demonstrated that the primary outcomes, including both the Constant-Murley Shoulder scores (p=0.65) and DASH (p=0.26) scores, were not statistically significantly different between the IMF and plate fixation groups. The IMF group was statistically significantly favoured for outcomes including the pooled incidence of complications not requiring non-routine surgery (p=0.01), infections (p=0.002), nerve injury-associated complications (p=0.006), and cosmetic dissatisfaction (p=0.0003). In the subgroup analysis of studies including and excluding comminuted clavicle fractures, the pooled incidence of infections was statistically significantly reduced in the IMF group for both subgroup analyses.