Objective To evaluate the clinical effect of the modified paratricipital approach in the treatment of distal humeral fractures. Methods On the basis of the paratricipital approach, we expanded the exposure through extending the incision distally, stripping the elbow muscle, partial flexor tendon, and finally overturning the medial and lateral condylar. 13 cases of distal humeral fractures were treated via the modified approach, there were 2 cases of C1 type, 7 cases of C2 type and 4 cases of C3 type according to the AO classification. The fracture healing, operative complications, elbow range of motion and elbow function were observed. Results All patients were followed up for an average of 14.23 months. No infection, flap necrosis occurred during the follow-up. All fractures were union with an average time of 9.62 weeks. At the last follow-up, the elbow joint range of motion was 107.3 ° and MEPs score was 90.38, with 9 cases excellent, 3 cases good and 1 case fair. There were 3 cases of ulnar nerve injury and 1 case of mild heterotopic ossification. Conclusion The modified paratricipital approach does not damage the elbow extension device and has a wide exposure range. It can effectively treat most distal humeral fractures with satisfactory results.