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Background: The number of displaced midshaft clavicle fractures treated surgically is increasing, and open reduction and intramedullary fixation is an emerging surgical treatment option. The study quality and scientific levels of published evidence in which possible complications of this treatment are presented vary greatly. Methods: We performed systematic computer-based searches of EMBASE and PubMed/MEDLINE. Studies included for review reported complications after intramedullary fixation alone or in comparison to either treatment with plate fixation and/or nonoperative treatment. The Level of Evidence rating and Quality Assessment Tool were used to assess the methodological quality of the studies. Included studies were ranked according to their levels of evidence. Results: Six articles were eligible for inclusion and final quality assessment; 3 studies were graded the highest level of evidence. Major complications like bone-healing problems and deep infections requiring implant removal were reported at a rate no higher than 7%. Reported rates for minor complications, such as wound infection and implant irritation that could be resolved without further surgery, were as high as 31%. Conclusion: The noted rates for major complications requiring additional surgery were low, but implant-related problems that require additional surgery might present with high prevalence. Owing to routine implant removal, treatment with intramedullary fixation often requires an additional surgical procedure. Contexte: Le nombre de fractures deplacees de la diaphyse claviculaire traitees chirurgicalement est en hausse et la reduction ouverte avec fixation intramedullaire est une option chirurgicale emergente. La qualite des etudes et le niveau scientifique des preuves publiees concernant les complications possibles de ce traitement varient beaucoup. Methodes: Nous avons procede a une interrogation systematique des bases de donnees informatiques EMBASE et PubMed/MEDLINE. Les etudes retenues pour examen faisaient etat de complications apres le recours a la fixation intramedullaire seule ou comparee a un traitement par plaque et vis et(ou) un traitement non chirurgical. Nous avons utilise le classement par niveaux de preuve ou un outil d'evaluation qualitative pour mesurer la qualite methodologique des etudes. Les etudes retenues ont ete classees selon leur niveau de preuve. Resultats: Nous avons retenu 6 articles pour inclusion et evaluation finale de leur qualite; 3 des etudes presentaient le niveau de preuve le plus eleve. Les complications majeures, notamment des problemes de cicatrisation de l'os et d'infection profonde necessitant le retrait de l'implant, ont ete signales selon un taux n'excedant pas 7 %. Les taux de complications mineures rapportees, telles qu'infection de plaie et irritation due a l'implant, qui ont pu rentrer dans l'ordre sans autre chirurgie, se sont eleves a 31%. Conclusion: Les taux signales de complications majeures ayant necessite une autre chirurgie ont ete faibles, mais les problemes relatifs aux implants ayant necessite une autre chirurgie pourraient etre plus prevalents. Compte tenu du retrait habituel des implants, le traitement par fixation intramedullaire requiert souvent une autre intervention chirurgicale., Fractures of the clavicle account for 5% of all fractures, and 80% of these fractures are located in the middle third of this S-shaped bone. (1-4) The incidence of surgical [...]