**Abstract**

Operative treatment of distal femoral fractures has evolved significantly in tems of strategy and implants available for fracture fixation. Major advances include improvements in fixation devices, as well as the understanding of the pathomechanics of fixation failures. As the complexity of the fracture increases, and in conjunction with considerations of the general status and functionality of the patient, judicious planning, surgical approach and choice of implants can be undertaken, in order to obtain optimal functional restoration. This goes along tightly with the capability of a given construct to withstand deforming forces, while early mobilization and weight bearing take splace, and ultimately bone healing occurs. Minimizing the risk of complications, such as hardware failure and nonunion, depend closely on proper planning and execution. Factors inherent to the patient and the fracture itself are beyond the surgeon's control. But taking these in mind, allows the surgeon to select properly the timing, surgical approach and choice of implant—or combination of implants—, best suited for a given patient.

**Keywords:** distal femoral fractures, mechanical failure, nail, plate fixation, surgical technique
