To compare open reduction and internal fixation (ORIF) with total elbow arthroplasty (TEA) for intraarticular distal humerus fractures in women older than 65 years of age. Retrospective review. Information was obtained from a Level 1 trauma center with fellowship-trained traumatologists and a tertiary care center with fellowship-trained shoulder and elbow surgeons. Patients were 24 women older than age 65 who sustained distal humerus fractures that required surgical treatment with clinical follow-up at a minimum of 2 years. All fractures were OTA classification 13.C2 or 13.C3. No patients were lost to follow-up. ORIF or TEA was the treatment method. The Mayo Elbow Performance score and the need for revision surgery were established as the means of patient evaluation. Using the Mayo Elbow Performance score, the outcomes of the 12 patients treated with ORIF were as follows: 4 excellent, 4 good, 1 fair, and 3 poor (cases that required conversion to TEA). Outcomes of the 12 patients treated with TEA were as follows: 11 excellent and 1 good. There were no fair or poor outcomes in the TEA group. No patients treated with TEA required revision surgery. We believe TEA to be a viable treatment option for distal intraarticular humerus fractures in women older than age 65. This is particularly true for women with associated comorbidities, such as rheumatoid arthritis, osteoporosis, and conditions requiring the use of systemic steroids.