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Purpose There is a debate about the choice of operative intervention in humeral shaft fractures requiring surgical intervention, intramedullary nailing (IMN) or dynamic compression plate (DCP).This meta-analysis was performed to compare fracture union, functional outcomes, and complication rates in patients treated with IMN or DCP for humeral shaft fractures, and to develop GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) based recommendations for using the procedures to treat humeral shaft fractures.Methods A systematic search of all studies published through December 2012 was conducted using the Medline, Embase, Sciencedirect, OVID and the Cochrane Central database.The randomized controlled trials (RCTs) and quasi-RCTs that compared IMN with DCP in treating adult patients with humeral shaft fractures and provided data on safety and clinical effects were identified.Demographic characteristics, adverse events and clinical outcomes were manually extracted from all of the selected studies.Results Ten studies encompassing 448 patients met the inclusion criteria.Overall, the result of meta analysis indicated that there were significant differences between IMN and DCP in intraoperative fracture comminution, shoulder impingement, restriction of shoulder range of movement, implant failure, and re operation rate.However, there were no significant differences in fracture union, ASES score, iatrogenic redial nerve injury, and infection.The overall GRADE system evidence quality was very low, which lowers our confidence in their recommendations.Conclusion Both IMN and DCP can achieve similar fracture union with similar incidence of radial nerve injury and infection.However, IMN was associated with increased risk of shoulder impingement, higher restriction of shoulder movement, increased risk of intraoperative fracture comminution, higher incidence of implant failure, and increased risk of re-operation.DCP may be superior to IMN in the treatment for humeral shaft fractures.Due to the very low evidence currently available, high-quality RCTs are required.