For many years, plating has proved to be a reliable method for the fixation of fractures of the humeral shaft. In the early nineties however, intramedullary devices became increasingly popular for fractures of the humeral shaft. This was based on a global tendency towards minimally invasive surgery, and the attractiveness of the relatively simple procedure and potentially lower complication rate of intramedullary nailing, which had proved to be successful in osteosynthesis of the lower limb, However, until now there is no consensus in the literature as to which device is preferable for different indications. We reviewed 161 patients, operatively treated for a fracture of the humeral shaft in our department between 1986 and 1999. Our experience shows in most indications a higher union rate, better functional results and a lower reoperation rate after plate and screw fixation. In addition, even though plating requires a more technically demanding procedure, in experienced hands, it gave rise to fewer iatrogenic fractures, and fewer persisting pain problems. We recommend the use of plate and screws as primary treatment in all operative indications, except for pathological fractures, very obese patients, and open fractures.