Abstract: Objective To observe the clinical efficacy of two surgical approaches in the treatment of type C distal humeral fractures. Methods A total of 40 patients with type C fractures of distal humerus were divided into group A and group B. The group A treated by bilateral triceps brachii approach, while the group B treated by olecranon osteotomy approach. The function was evaluated by the Mayo Elbow Performance Score. Results Out of 40 cases, ulnar nerve was injured in 1 case, and there was no loosening or fracture of internal fixation, all of them had bone healing. The Mayo Elbow Performance Score showed that the excellent rate in the group A was 75.0%, and 65.0% in group B, there was no significant difference between the two groups(P>0.05). There were statistically significant differences in incision length, operation time and intraoperative bleeding between the two groups(P<0.05). There were no statistically significant differences in average follow-up time and fracture healing time(P>0.05). Conclusion Two surgical approaches for distal humerus type C fractures combined with early postoperative functional exercise show good efficacy. Olecranon osteotomy approach is a preferred option for severe C3-type comminuted fracture and articular surface damage.