Intramedullary nailing still remains the golden standard for the treatment of diaphyseal fractures of the long bones in adults. The operative technique is standardised and usually minimal invasive, the primary healing rate is high, and complications arise rarely. However, for problem zones (meta-diaphyseal region), in poor bone quality and in other relative contraindications for nailing (narrow medullary canal, fractures in adolescents and polytrauma) the new angular stable screw-plate-systems (LISS, LCP) offer an excellent alternative for the operative stabilisation. The high primary stability in combination with newly developed minimal-invasive techniques (MIPO = minimal invasive plate osteosynthesis) are the bases for a functional after treatment and a rapid bony consolidation with a low complication rate.