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Objective: The aim of this retrospective study was to investigate clinical effects of the treatment of intra-articular distal humeral fractures via the combined posterior olecranon osteotomy and anterior approach and the combined lateral Kaplan approach associated with the medial approach. Methods: Between July 2010 and September 2019, 28 cases of intercondylar fractures of the distal humerus (AO/OTA type C) were treated by open reduction and internal fixation (ORIF) via the posterior and anterior approach and combined lateral-medial approach, which were divided into the P-A (n = 13) and L-M (n = 15) groups, respectively. The outcomes in terms of function were assessed using the range of motion (ROM) of the elbow and forearm, humerotrochlear (HT) angle, Visual Analogue Scale (VAS) scores, Mayo Elbow Performance Score (MEPS), and efficacy grade evaluated using the scoring system of Orthopaedic Trauma Association (OTA) at the one-year follow-up. Results: The flexion-extension of elbows and pronation-supination of forearms were respectively 114.1° ± 12.4° and 157.3° ± 9.6° in the P-A group and 117.1° ± 14.5° and 161.3° ± 10.7° in the L-M group. No significant difference was observed between the two groups for the elbow and forearm ROM (p > 0.05). Furthermore, surgery duration, blood loss volume, HT angle, MEPS, VAS scores, OTA rating, and the morbidity of postoperative complications during the one-year follow-up did not differ between groups. Conclusion: The posterior olecranon osteotomy and anterior approach can be used efficiently for exposure of complex distal humeral injuries with similar clinical efficacy and complications in the treatment of intra-articular distal humeral fractures as compared to the lateral-medial approach.