Background <p>Minimally invasive plate osteosynthesis (MIPO) has been increasingly used for midshaft clavicle fractures, with proposed advantages in reducing soft tissue injury and nerve-related complications. However, whether MIPO provides additional benefit over nerve-preserving open reduction and internal fixation (ORIF) remains unclear.</p> Methods <p>A systematic review and meta-analysis was conducted according to PRISMA guidelines. Studies comparing MIPO with nerve-preserving ORIF for midshaft clavicle fractures were included. Primary outcome was supraclavicular nerve (SCN)–related sensory disturbance. Secondary outcomes included functional scores, operative time, blood loss, fracture union time, return to activity, and complications. Random-effects models were used, and prespecified subgroup analyses were performed based on incision strategy, SCN identification, and study design.</p> Results <p>A total of 10 studies involving 500 patients (3 randomized controlled trials and 7 retrospective studies) were included. MIPO was associated with a lower incidence of SCN-related sensory disturbance compared with nerve-preserving ORIF (RR 0.34, 95% CI 0.23–0.50), with no observed heterogeneity. This finding was consistent across subgroup analyses, including randomized controlled trials. Functional outcomes, fracture union time, and overall complication rates were generally comparable between techniques. MIPO was associated with reduced intraoperative blood loss and shorter time to return to activity, although these findings were based on a limited number of studies and showed heterogeneity. Operative time tended to be shorter with MIPO but demonstrated substantial variability across studies.</p> Conclusions <p>MIPO is associated with a lower incidence of SCN-related sensory disturbance compared with nerve-preserving ORIF. This advantage appears consistent across variations in surgical technique, while other outcomes are generally comparable between techniques.</p>