Background:Of all clavicle fractures, midshaft fractures account for between 69% and 81% of cases. The present study was conducted to compare outcome of titanium elastic nailing system (TENS) versus non- operative treatment of midshaft clavicle fractures. Materials & Methods:70 patients with midshaft clavicle fractures of both genderswere divided into 2 groups of 35 each. Group I patients were treated with 2 mm titanium elastic nail. Group II patients were treated by conservative management by means of figure of eight bandage with cuff and collar. Parameters such as time to bony union, shortening of clavicular length, constant shoulder score, the disabilities of the arm, shoulderand hand (DASH) score were recorded. Results: In group I, males were 25 and females were 10 and in group II, males were 21 and females were 14. The mean time to bony union was 13.4weeks and 17.2weeks in group I and II respectively. The mean shortening of clavicular length was 4.3 mm and 9.6 mm in group I and II respectively. The mean DASH score was 92.6 and 74.2 in group I and II respectively. The mean constant shoulder score was 70.4 and 55.6 in group I and II respectively. The common complications was non- union seen in 2 in group II, hardware prominence in 3 in group I and infection in 2in group I and 6 patients in group II. The difference was significant (P< 0.05). Conclusion: For the fixation of misplaced midshaft clavicular fractures, titanium elastic nailing system offers an appropriate substitute technique that produces satisfactory outcomes for middle third fractures of the clavicle.