The purpose of this retrospective study was to evaluate the outcome of headless screws and Mini-plate for treating Type B3 fractures of distal humerus. Seventeen patients with type B3 fracture were included and divided into headless screws group and Mini-plate group. Outcome was evaluated using Mayo Elbow Performance Score (MEPS), Short form 36 questionnaire (SF-36), visual analog score (VAS), and range of motion (ROM) at 12 months' follow-up. All patients received a minimum follow-up of 12 months. Postoperative complications mainly included elbow stiffness, heterotrophic ossification and elbow instability. At 12months' follow-up, the MEPS and physical components score of SF-36 in Mini-plate group were significantly higher than that in screw group. Moreover, cases undergoing Mini-plate treatment showed a tendency towards improved ROM of elbow and VAS. The Mini-plate was superior to headless screws on elbow function restoration in the management of type B3 distal humerus fractures.