Bicondylar distal humerus fractures are difficult injuries requiring a comprehensive treatment strategy. Non-operative treatment is generally reserved for elderly, low demand patients and those whose medical co-morbidities preclude surgery. Considerations for surgery include fracture morphology, osteoporotic bone quality, and degree of articular comminution. Surgical treatment with plate fixation is a reliable solution to facilitate early mobilization for a functional recovery. In fractures not amenable to operative fixation, implant arthroplasty may provide improved functional results. Satisfactory outcomes following such injuries can be achieved through surgical fixation and arthroplasty, allowing for early rehabilitation and elbow motion to facilitate a functional recovery. Postoperative complications remain a concern in managing these fractures. In this review, we share our recommendations for management of bicondylar fractures of the distal humerus.