Introduction: Distal humeral fractures have an estimated incidence in adults of 5.7 per 100,000 persons per year. The concept of orthogonal locking plating, which involves placing one plate along the medial column of the distal humerus and the other plate along the lateral column, with the screws in the distal fragment interdigitating with each other, restoring the ‘tie-beam arch’ of the distal humerus. 

Materials and Methods: This retrospective trial involves 37 patients with distal humerus AO type C operated between May 2018 and Feb 2020 at a tertiary care canter in Navi-Mumbai, India with orthogonal plating with 13 patients operated with paratricipital approach and 24 patients operated with olecranon osteotomy. The results were analyzed with the DASH scoring system and MEPS.

Results: of 37 patients operated 15 were male and 22 were female, depending on the surgeon’s preference, 4 cases of type C1 and 9 cases of type C2 were operated on with triceps sparing approach and all Type C3 fractures were operated with olecranon osteotomy approach. All the cases showed bone union at 8.4 weeks ± 2.3 weeks, no case showed non-union or malunion, 2 cases showed superficial infection but did not require any surgical intervention and were managed with oral antibiotics, and one case developed a deep infection which later on developed chronic osteomyelitis and fixed flexion deformity, was managed with hardware removal at 15 months after repeated wound wash and debridement.

Conclusion: The present study observed orthogonal dual plating for AO Type C distal humerus fractures to be an effective surgical option as it helps in achieving good anatomical reconstruction, stable fixation, and early mobilization.