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Fractures of the shaft of the clavicle are common in both adults and children. Recent adult studies have indicated that improved outcomes are achieved after open reduction and internal fixation. The purpose of this study was to analyze outcomes after open reduction and internal fixation of displaced clavicle shaft fractures in children.We analyzed a retrospective case series of 24 children whose displaced clavicle shaft fractures were treated through open reduction and internal fixation. Special attention was paid to the rate of healing, radiographic outcomes, functional outcomes, and complications.Twenty-four children with an average age of 12 years and 8 months (range 7 to 16 y) had their closed unilateral clavicle shaft fractures treated via open reduction and internal fixation. Patients were followed for an average of 2 years and 2 months. There were no deep or superficial infections and no nonunions. Eighty-seven percent (21 of 24) of children returned to unrestricted sports activities. Two patients suffered from scar sensitivity and 1 patient experienced a transient ulnar nerve neurapraxia secondary to their initial injury. All fractures healed and all orthopaedic implants were later electively removed.We conclude that open reduction and internal fixation of displaced clavicle shaft fractures in children can be performed safely.Level 4, therapeutic study (retrospective case series).