Prospectively, 40 patients with an average age of 45 (20–65) with closed transverse fractures of the middle one-third of the humerus without associated radial nerve palsy were treated. All had failed nonoperative reduction and were then operated on with either compression plating or intramedullary fixation with Hackethal nails and a postoperative ready-made fracture brace. These surgeries were performed at an average of 7 days (4–10) after closed reduction. The Hackethal nailing group consisted of 20 patients (17 men, 3 women) with a mean age of 47 years (22–64); within 2 days after surgery the patients were allowed to begin active and passive range-of-motion exercises of the elbow and the shoulder with the arm protected by a ready-made fracture brace; the average follow-up period for this group was 18 months (12–50). These patients (with one exception) required a second surgical procedure with a second anesthesia to remove the symptomatic nails; moreover, they had to be protected in a brace for 6 months. The compression plate group consisted of 20 patients (14 men, 6 women) with a mean age of 45 years (20–65); within 2 days after surgery the patient was allowed to begin the same rehabilitation program; in this group no braces were used postoperatively. All fractures treated with Hackethal nailing healed except for one delayed union. Functional results in this group were 12 excellent, 4 good, 1 fair, and 3 poor. All fractures treated by compression plating healed except in one case of delayed union. Additionally there was one superficial infection and one wound hematoma. Functional results in this group were: 13 excellent, 3 good, 2 fair, and 2 poor. In this study, no differences have been found between the two investigated surgical procedures; when operative treatment is necessary for the management of closed transverse fractures through the middle one-third of the humerus failing nonoperative reduction, either compression plating or Hackethal nailing has proved equally effective. However, disadvantages of the Hackethal system include postoperative bracing and a secondary surgical procedure to remove the nails.