Objective <p>The objective of this study was to assess outcomes of ballistic distal humeral fracture in comparison with open and closed distal humeral fractures sustained via blunt mechanisms.</p> Design <p>Retrospective cohort study.</p> Setting <p>Academic Level I trauma center.</p> Participants <p>Skeletally mature patients presenting with ballistic (17), blunt open (36), or blunt closed (94) distal humeral shaft fractures (AO/OTA 13A-C).</p> Main outcomes <p>Number of unplanned reoperations, intensive care unit admission, persistent ulnar nerve neuropathy, nonunion, superficial infection, deep infection, heterotopic ossification formation, hardware removal, and length of stay.</p> Results <p>A total of 147 distal humeral fractures that underwent operative fixation were included in the study. A group of 17 ballistic fractures and comparison groups of 36 open and 94 closed distal humeral fractures sustained via blunt mechanisms was identified. Compared with the blunt closed group, the ballistic group had a higher proportion vascular injury (<i>p</i> = 0.001), preoperative ulnar nerve injury (<i>p</i> &lt; 0.001), and longer operative times (<i>p</i> = 0.007). Compared with the blunt open group, the ballistic group sustained a higher proportion of preoperative ulnar nerve injuries (<i>p</i> = 0.012), required less olecranon osteotomies (<i>p</i> = 0.045), and had fewer unplanned reoperations (<i>p</i> = 0.043).</p> Conclusion <p>Ballistic distal humerus fractures sustain high rates of neurologic and vascular injury but have similar short term outcomes to blunt closed fractures.</p> Level of evidence <p>Prognostic Level III.</p>