There are various treatment options for frontal sinus fractures. They mainly depend on whether the anterior or posterior table and the frontal sinus outflow tract (FSOT) are affected. Our study retrospectively assessed the surgical management of 116 frontal sinus fractures in terms of the different surgical treatment options as well as the resulting complications. In our cohort, all cases of displaced anterior table fractures (n = 73) were treated by open reduction and fixation (ORIF). In cases of posterior table fractures (n = 43), cranialization, obliteration, sinus preserving measures, or no treatment were carried out. Pyomucocele was the most common complication, occurring in 8.6 % of cases. It was significantly more frequent with dislocation of the posterior table without treatment (p = 0.003). Cerebrospinal fluid (CSF) leakage was especially observed in combined anterior and posterior table fractures (p = 0.012) and in cases of accompanying centrolateral midfacial fractures (p < 0.001). Poor aesthetic outcome was significantly more frequent with concomitant nasoethmoidal fracture (p < 0.001). CSF leakage and cosmetic defects seem to depend mainly on the severity of the trauma and the accompanying injuries. Reconstruction of the posterior wall and sealing it with autologous grafts appears to be an effective method of preventing CSF leakage and pyomucocele in most cases.