Objective  To investigate the efficacy of Hebert screw internal fixation of osteoporotic distal humeral coronary fractures in the elderly.   Methods  A retrospective case series study was conducted to analyze the data of 26 elderly patients with osteoporotic distal humeral coronary fractures treated in Changhai Hospital from December 2011 to December 2018, including 3 males and 23 females aged 56-84 years (mean, 67.8 years). According to Bryan-Morrey classification, there were 7 patients with type I, 11 with type III, and 8 with type IV. All patients received open reduction and internal fixation. Among the 26 patients,10 patients with simple humeral head fractures were treated with Hebert screw internal fixation, and 16 patients with humeral head fractures combined with humeral epicondyle fracture were treated with Hebert screw combined with humeral condyle miniplate. Operation time and intraoperative bleeding volume were recorded.  At last followup, elbow range of motion were measured, and Mayo elbow performance score and visual analog scale (VAS) score were assessed.  Meantime, complications were observed.   Results  A total of 22 patients were followed up for 6-57 months (mean, 31.8 months). Intraoperative bleeding volume was 100 to 245 ml (mean, 126 ml) and operation time was 60 to 195 minutes (mean, 85 minutes). At last follow-up, the elbow joint flexion was (117.3±4.2)° and extension was (8.2±2.1)°. Mayo elbow performance score improved from preoperative 16.5 (12.8,24.0)points to postoperative 85.0 (82.5,92.3)points (P＜0.05). VAS was increased from preoperative (9.6±0.5)points to (2.3±0.2)points  at latest follow-up(P＜0.05).  Two patients had elbow joint stiffness after operation and recovered after functional exercise. One patient had bone displacement when receiving rehabilitation care, which did not affect the function, and hence no further treatment was given. All patients had no infection or skin and soft tissue complications after surgery. Conclusions  For osteoporotic distal humeral coronary fractures in the elderly, Hebert screw internal fixation is effective in facilitating function recovery and relieving pain. When the fracture is combined with lateral humeral condyle fracture, additional plate fixation can be used for rigid stabilization.