13 studies with a total of 895 patients with midshaft clavicle fractures were included in this systematic review and meta-analysis comparing intramedullary nailing (n=457) to plate fixation (n=438). The primary outcome of interest was function, measured using the Constant Shoulder Score or the Disabilities of the Arm, Shoulder, and Hand (DASH) score; secondary outcomes of interest included operative outcomes and complication rates. The results of the meta-analysis found significantly better Constant and DASH scores at 1 year in the intramedullary nailing group compared to the plate fixation group. Moreover, intramedullary nailing led to significantly lower pooled operative time, wound length, blood loss, and union time, as well as lower odds of infection, major complications, and revision surgery.