Objective To evaluate the effects of different approaches on the management of the middle and distal thirds of the humeral fractures.Methods 93 patients were divided into two groups randomly.48 cases were treated by the posterior approach and 45 cases by the anterolateral approach.Results In the anterolateral approach group complication of radial nerve injury occurred in 12 cases and nonunion in 5 cases.While in the posterial approach group Complication of radial nerve injury in 4 cases and nonunion in 2 cases.No significant difference was found between the two groups in terms of associated bone union,while significant difference existed between the two groups in terms of associated radial nerve injury.Conclusion The posterior approach is a better choice and safer in management of the middle and distal thirds of the humeral fractures.