Fractures of the distal humerus are overall rare fractures with a bimodal incidence in young (12–19) and old (80+) patients. Patients will complain of pain and swelling over the elbow with decreased range of motion. A detailed exam is compulsory as displaced fractures may endanger all neurovascular structures crossing the elbow. Imaging, including traction x-rays and CT, will distinguish amount of articular involvement. Treatment options will be based on patients’ individual demands and include open reduction internal fixation, total elbow replacement and nonoperative “bag of bones”. Isolated fractures of the capitellum are a particular challenge as fixation is balanced against disruption of blood supply. Complications of operative and nonoperative management include stiffness, nonunion, ulnar nerve palsy, heterotopic ossification, failure of fixation and infection.