Anterior approach to the elbow through an oblique incision across the elbow crease, with the deep exposure reaching the coronoid process in the floor of the cubital fossa. Image from Jia Q, Li X, Zhan J, Chen D, Liu K, Wang Y, Yusufu A, Ma C. A new attempt to treat coronal plane fractures of the elbow joint with salvage via an anterior approach. BMC Surg. 2022, 22(1), 257. CC BY 4.0.

The anterior approach to the cubital fossa exposes the distal biceps tendon, median nerve, brachial artery and anterior elbow joint. It is used for distal biceps repair and for nerve or vascular exploration, protecting the lateral antebrachial cutaneous nerve and the radial nerve and its branches.

Anterior Approach to Cubital Fossa, radial and ulnar arteries arising in the cubital fossa, gray’s anatomy plate 528 — Radial and ulnar arteries arising in the cubital fossa, Gray’s Anatomy plate 528. Image by Henry Vandyke Carter, Wikimedia Commons, Public domain.

Indications

Reinsertion of biceps tendon
Release of anterior capsular contractions
Repair of nerves
Exploration of the pulseless pale paediatric supracondylar humeral fracture

Position

Supine
Armboard

Landmarks

Brachioradialis
Tendon of biceps
Anterior elbow crease

Incision

Curved longitudinal gentle S shaped incision over anterior aspect of elbow
Start: 5cm above elbow crease on medial side of biceps
Cross elbow crease obliquely
End: continue on the medial border of brachioradialis

Internervous Plane

Proximally
- Brachioradialis
  - Radial nerve
- Brachialis
  - Musculocutaneous nerve
Distally
- Brachioradialis
  - Radial nerve
- Pronator teres
  - Median nerve

Superficial Dissection

Ligate numerous veins
Identify & preserve lateral cutaneous nerve of forearm
- Between biceps & brachialis
Identify bicipital aponeurosis & incise it close to its origins at the biceps tendon
- Being wary of brachial artery which runs deep to aponeurosis
Identify radial artery & trace it proximally to its origin in the brachial artery
- Brachial vein & median Nerve run medial to artery

Deep Dissection

Develop plane between
- Medially biceps & brachialis
- Laterally BR
Supinate forearm
Incise origin of supinator

Dangers

Lateral cutaneous nerve of forearm
Radial artery
PIN

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.