In intraarticular fractures of the distal humerus, full functional recovery is difficult to obtain. Even if stable anatomic reconstruction of the articular surface is achieved by open reduction and internal fixation, nerve lesions, joint stiffness, and heterotopic bone formation may spoil the functional result. Ninety-nine consecutive fractures were treated by open reduction and internal fixation and studied retrospectively to determine factors influencing outcome. Followup examination of 77 cases showed 52% excellent and good late results. Twenty-six patients had nerve injuries. The rate of heterotopic bone formation was 49%. Open fractures and polytraumatized patients had less favorable results. Early operations within 24 hours resulted in significantly less heterotopic bone formation and better overall function that did delayed treatment. Careful examination of nervous deficits and early stable internal fixation with routine exposure of the ulnar nerve is therefore recommended in the management of this injury.