Intra-articular distal humerus fractures can be among the most challenging injuries treated by orthopedic surgeons. The goals of surgical treatment are anatomical restoration of the articular surface and stable fixation of the fracture fragments to allow for early motion. However, the bone stock of the distal humerus is limited, and stable fixation may be difficult to achieve in the case of a low fracture pattern, comminution, or osteoporosis. In this article, we provide practical recommendations for surgical management of these complex fractures.