Fragility distal femoral fractures are often associated to deficient bone stock and bone defect. Frail patients, who are characterized by their coexisting comorbidities, low functional status and frequent cognitive impairment, benefit from early intervention and mobilization. The use of polymethylmethacrylate bone cement in the case of distal femoral fractures with decreased screw purchase and bone defect is a valid option in frail non-ambulatory patients. Given an accurate patient selection, the immediate postoperative mobilization provided by the one-shot surgery presented in this paper procures substantial advantages.