Distal humeral fractures account for about one-third of humeral fractures in adults. Because of its complex anatomical structure and important physiological function, it requires high reduction and fixation, especially complex fractures. Knowledge of the anatomical morphology of the distal humerus, the specific types of fractures, and the characteristics and adaptive range of various surgical approaches plays a decisive role in the successful completion of the operation. With the development of internal fixation design and biomechanics research, the choice of plate and screw and the refinement of fixation mode have a crucial influence on the later functional recovery. The author reviews the etiology, anatomical morphology, fracture types, surgical approaches and internal fixation options of complex distal humerus fractures in adults, providing references for clinical diagnosis and treatment.