Background Coronal fracture of distal humerus is a rare intra-articular injury involving the articular surface of capitellum and trochlea, and it accounts for approximately 0.5%-1.0% of the fractures of elbow. Fractures of this type are easily missed. Numerous surgical approaches and types of internal fixation have been reported in literatures, but no conclusions are formed. From January 2010 to June 2013, 17 patients with type B3 fractures of distal humerus were surgically treated with anti-glide plates and 3.0mm HCS headless cannulated screws through lateral elbow approach to investigate the operative methods and their outcomes.Methods (1) General information:From January 2010 to June 2013, 17 patients with type B3 fractures of distal humerus were surgically treated with anti-glide plates, including 9 male and 8 female. The age ranged from 25-71 years and the average age was 42.1 years. Nine cases fractured in left side and 8 cases in right side. Causes of injury: fall from body height in 13 cases, motor accident in 3 cases and fall from meters high in 1 case. All patients were closed injury with no nerve or vascular damage. According to the AO classification, ten cases were type B3.1 fracture and seven were type B3.3. Through the lateral elbow approach, anti-glide plates combined with 3.0mm HCS headless cannulated screws were used after anatomical reduction. The operation time from injury were 3-4 d.(2)Operative methods: After successful brachial plexus block or general anesthesia, the patient was placed in supine position with pneumatic tourniquet applied. An incision of about 8 cm was made from 5 cm proximal to the lateral epicondyle of humerus, along the lateral humerus downward across epicondyle to the level of radial head. After each layer was opened, the muscular layer was dissected between the extensor carpi radialis muscle and extensor digitorum muscle. The carpi radialis muscle origin was reflected and the lateral elbow joint capsule was incised from proximal to distal to expose the capitellum and trochlea. Intra-articular hematoma, fragments and cartilage were carefully debrided during the operation. Fracture fragments were anatomically reduced and provisionally fixed by Kirschner wire. The 3 mm HCS headless cannulated screws were chosen for fixation from anterior to posterior or vice versa after satisfactory reduction had been checked under intraoperative fluoroscopy. An anti-glide plate or T plate was used for moulding. The plate should be placed near but not protrude to the articular surface. The full range of motion of elbow joint was checked. It should be clear that the plate would not block normal flexion. Reduction of the fracture and screw length was confirmed by fluoroscopy with C arm. The wound was closed in layers and drainage device was removed within 48 hours postoperatively.(3)Postoperative Management:Antibiotics were used to 30 min before operation and within 24 hours postoperatively. Indomethacin was taken orally for the first 6 weeks with 25mg each time and 3 times per day. Active and passive motions of elbow joint were begun when patient could tolerate after surgery, and the range of motion was increased gradually. All patients were routinely followed up at the 1st, 2nd, 3rd and 6th month after operation.Results All patients were followed up for 6 to 12 months with an average of 8 months. The fractures had full union with no infection, vascular and nerve damages, or myositis ossificans. No complications such as heterotopic ossification of elbow joint, traumatic arthritis, ischemic necrosis of capitellum, loosening or breakage of internal fixation and loss of reduction were seen. The mean range of moiton of elbow joint was 10° of extension and 110° of flexion. The Broberg-Morrey score averaged 90.5 with 8 excellent cases, 7 good cases, 1 normal case and 1 bad case, and the excellent and good rate was 88.2%.Conclusion With the application of anti-glide plate combined by 3.0mm HCS, the treatment of type B3 fractures can get a reliable and effective fixation, allow early functional exercise, and achieve satisfactory clinical outcomes.