Independently of lacerated anatomic structures, the ensuing fracture type, concomitant injuries around the joint, the primary aim in treating distal humeral fractures is the restoration of a painfree, mechanically loadable elbow that has a free range of motion. To achieve these goals the fracture and its associated injuries have to be adequately diagnosed, adequately surgically treated, and after reconstruction must undergo an early physical therapy (PT) protocol. Adequate diagnostics, except for standard X-ray films, include in most cases an additional preoperative CT for evaluation and planning of the surgical approach. Adequate surgical treatment entails anatomic reconstruction and stable fixation via an approach that causes a minimum of additional iatrogenic injury to the adjacent soft tissues. Adequate PT is synonymous with early onset of movement, i.e. as early as the 1st postoperative day if the fixation is stable enough. However, a demanding problem is the increasing number of osteoporosis-associated distal humeral fractures in the elderly population with the development of complex fracture types, partly due to poor bone quality, that are not easily addressed and might lead to unsatisfactory results even after applying standardized protocols including anatomically contoured angular stable plates.