6 randomized controlled trials (RCTs) and 9 non-randomized controlled trials were included in the present investigation. The analysis was performed to determine if the fixation of midshaft clavicle fracture with intramedullary nailing could achieve superior surgical outcomes without compromising union rates or safety when compared to plate fixation. Significantly lower blood loss, operative time, surgical wound size, length of hospital stay, and time to union were reported in patients undergoing intramedullary fixation in comparison to plate fixation, as were significantly lower overall and major complications. Union rate, shoulder score, and secondary complications were found to be comparable between groups. However, these results should be interpreted with caution as few RCTs were identified, and while findings remained robust when conducting analyses in only RCTs, these assessments were limited by the number of patients included.