Background: Distal humeral fractures in adults, particularly AO/OTA Type C fractures, are complex intra-articular injuries that demand precise anatomical reduction and stable fixation to restore elbow function. These fractures often result from high-energy trauma and pose challenges due to the distal humerus' intricate anatomy and limited bone stock. Bicolumnar plating, using either orthogonal or parallel configurations, has emerged as a reliable surgical method to achieve stable fixation and early mobilization, which are essential for optimal functional recovery and prevention of joint stiffness. Method: This prospective study included 28 adult patients with AO/OTA Type C distal humeral fractures treated with open reduction and internal fixation using bicolumnar plating. Patients were operated on using either orthogonal or parallel plating techniques via olecranon osteotomy or triceps-sparing approaches. Ulnar nerve transposition and olecranon repair techniques were recorded. Postoperative care included standardized physiotherapy. Functional outcomes were assessed using the Mayo Elbow Performance Score (MEPS), and radiological union, range of motion, and complications were documented over a one-year follow-up period. Result: In this study of 28 patients with Type C distal humeral fractures, the mean age was 45.2 years, with males comprising 64.3%. Road traffic accidents were the leading cause (64.3%). Most patients underwent olecranon osteotomy (82.1%) with orthogonal plating (64.3%). Functional outcomes were favorable, with a mean MEPS of 88.6; 57.1% had excellent results. Radiological union occurred in 14.8 weeks on average. Complications included ulnar neuropathy (21.4%) and hardware irritation (14.3%). C1 fractures and orthogonal plating showed better functional outcomes. Conclusion: We found that anatomical reconstruction and rigid bicolumnar fixation in adult distal humerus Type C fractures yields favourable outcomes. Orthogonal plating may offer advantages in elbow mobility, however, both configurations are effective when applied appropriately. Fracture complexity can impact prognosis significantly; therefore, emphasis should be on individualized surgical planning and execution.