Objective: To investigate the effect of olecranon V-shaped osteotomy and triceps brachii bilateral approach in the treatment of adult distal humeral type C fracture and compare the two approaches. Methods: From October 2016 to October 2017, 33 adult patients with type C distal humeral fracture were treated by two surgical approaches in Third Hospital Affiliated to Anhui Medical University. There were 15 cases in olecranon osteotomy group and 18 cases in triceps brachii muscle bilateral approach group. The operative effect was evaluated by comparing the operation time, intraoperative bleeding volume, complications and so on of the two groups. Results: All patients were followed up for 12 to 18 months and achieved primary wound healing without infection and internal fixation loosening. In the olecranon osteotomy group, the operation time was longer (P<0.05), the amount of bleeding and drainage were more (P<0.05), and the complications were more (P<0.05). There was no significant difference in the time of bone healing, the ROM of elbow joint and the MEPS of elbow joint (P>0.05). Conclusion: The olecranon osteotomy approach has more exposure to the fracture end and articular surface, but the operation time is longer and the trauma is greater, which is more suitable for type C3 fractures. For the triceps brachii bilateral approach, the exposure of the fracture end and articular surface is not as good as olecranon osteotomy approach. It is more suitable for C1 and C2 fractures.