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This study reports on elementary mathematics teachers’ decisions in designing and implementing a fraction unit aligned with reform-oriented learning and teaching practices and the factors that influence their decisions. Four 4th grade teachers from different schools designed a fraction unit and implemented it in their classrooms. The data sources include video-recordings of unit design sessions and classroom unit implementation; semi-structured interviews including beliefs questions; and a survey on beliefs in addition to a fraction survey with items to determine teachers’ levels of mathematical knowledge for teaching. The findings suggest that one of the teacher’s relatively high level of MKT and her mathematical beliefs compatible with reform-oriented ideas might have affected her decisions that enabled her to implement the unit differently.