Comparative Review of Intramedullary Nailing and Plate Fixation in the Management of Humeral Shaft Fractures

Humeral shaft fractures account for approximately 1–5% of all skeletal injuries and represent a frequent cause of orthopaedic trauma in adults (1). While conservative management with functional bracing can provide satisfactory outcomes in many cases, surgical fixation is often indicated in patients with unstable, open, segmental, or polytrauma-related fractures. Among the various fixation methods, intramedullary nailing (IMN) and plate fixation remain the two most commonly used techniques. Each has distinct mechanical and clinical advantages. This review provides a comparative analysis of IMN and plating for humeral shaft fractures, discussing union rates, functional outcomes, complication profiles, and the impact of recent innovations such as minimally invasive plate osteosynthesis (MIPO) and third-generation straight nails. Evidence from randomized controlled trials, systematic reviews, and meta-analyses published between 2000 and 2025 is critically examined to summarize the relative merits of both approaches.