Fractures of the humeral shaft comprise 1% to 3% of all fractures. Incidence rates reveal a bimodal distribution in which there is one small peak during adolescence, followed by a larger spike during the fifth and sixth decades of life. Most humeral diaphysis fractures are simple patterns of the mid-diaphysis. This article emphasizes surgical approaches to humeral fractures, providing a review of the surgical spectrum of treatment inclusive of intramedullary nailing and plating, but also includes a brief discussion of the conservative approach.