The article presents the results of the treatment of 103 patients with intraarticular fractures of the distal humerus over the period from 2002 to 2020, who were under treatment at National Medical Research Center for Traumatology and Orthopedics named after N.N. Priorov and in the State Clinical Hospital named after Eramishantsev. All patients underwent surgical treatment of intraarticular fractures in various ways, depending on the nature and location of the damage. Osteosynthesis with excision of the ulnar process was used in 38 (36%) patients. Fixation of fractures without cutting off the ulnar process through the tendon of the triceps muscle of the shoulder was made in 43 (41%) patients, in 22 cases (23%) they performed osteosynthesis with Hebert screws. The paper presents in detail surgical approaches for various cases of fractures. Based on a retrospective analysis of the results, an algorithm for choosing the method of osteosynthesis for various fracture localization has been developed. The results were evaluated using the Mayo Elbow Performance Score. The developed algorithm for choosing surgical access, depending on the location of the fracture, selects the optimal access to obtain good functional results. A significant (p <0.05-0.001) increase in the number of positive functional results during surgical treatment by 47.6%, with a simultaneous decrease in the duration of rehabilitation treatment by 33.8% was noted as a result of the proposed tactics of treatment of intra-and periarticular fractures of the distal shoulder bones. © 2020, Advanced Scientific Research. All rights reserved.