Juxta- and intraarticular fractures of the knee (floating knee), intraarticular fractures with severe soft tissue damage and knee dislocations with vascular or soft tissue lesions are defined as complex knee trauma. A specific management protocol is required for these cases. Fractures should be treated with soft-tissue sparing minimal invasive reduction and fixation techniques to reduce the significant complication rate which is presently encountered. Percutaneous plate fixation, percutaneous screw osteosynthesis and hybrid fixation should be widely used in these cases. In knee dislocation, the central pivot with the two cruciate ligaments should be reconstructed using augmented repair or primary tendon grafting in every case, whereas the treatment of collateral ligament lesions depends on the specific injury type.