Distal humeral fractures (DHFs) are complex injuries in orthopedic practice, posing significant challenges due to the intricate anatomy and biomechanics of the elbow. These fractures exhibit a bimodal epidemiological pattern, with high-energy trauma affecting younger patients and low-energy falls in the elderly, often linked to osteoporosis. This chapter provides a comprehensive overview of DHFs, integrating recent literature on diagnosis, classification, and treatment. We discuss the critical role of advanced imaging, such as computed tomography (CT) with 3D reconstruction, in preoperative planning. The gold standard for displaced fractures is open reduction and internal fixation (ORIF), with modern angular-stability plates demonstrating improved outcomes. The chapter also explores total elbow arthroplasty (TEA) as a viable option for unreconstructable fractures in elderly patients. A meticulous, individualized rehabilitation plan is essential for optimal recovery and restoring function. By summarizing the latest clinical evidence, this chapter aims to guide clinicians in effective management strategies to enhance patient care and outcomes.