Objective To determine the strengths and weaknesses between parallel double plating and perpendicular double plating in the treatment of elderly distal humeral fractures. Methods Clinical data of 39 elderly patients (mean age 64 years, ranging from 60 to 81years) with distal humerus fractures who underwent parallel double plating (n=18) or perpendicular plating (n＝21) in Chinese PLA General Hospital from September 2008 and January 2013 were collected and retrospectively analyzed. Their surgical duration, blood loss, fracture healing time, flexion-extension arc, and the total range of flexion and extension were compared between the 2 groups. Mayo Elbow Performance Score (MEPS) was used to determine the elbow functional results. Results All patients were followed up for 12 to 25 months, with a mean duration of (17.0±1.5) months for perpendicular group and of (15.0±2.0) months for parallel group. For the former group, their mean MEPS was (82.0±5.6) points, and the rate of excellent and good results was 81.0%. While, for the latter, the mean MEPS was (83.1±5.5) points, and the rate of excellent and good results was 88.9%. No significant difference was seen in the surgical duration, blood loss, bone union time and functional results between the 2 groups. There were 2 cases of delay-union (finally healed after secondary operation) and 1 case of heterotopic ossification (mildly affecting postoperative outcomes) in the perpendicular group. Conclusion Although both methods provide sound anatomical reconstruction and stable fixation in the early term for distal humeral fractures in elderly patients, the parallel double plating is superior to perpendicular one in reducing the complications.