Medial Approach via Osteotomy

Medial approach with osteotomy of the medial epicondyle
Medial approach with osteotomy of the medial epicondyle. The ulnar nerve is held in a sling, the epicondyle is reflected with the flexor pronator mass and medial ligament, and valgus stress opens the joint to show the coronoid. Image from Ibrahim JM, van de Wall BJM, Michelitsch C, Perl K, Babst R, Beeres FJP. Medial elbow approach via a medial epicondyle osteotomy. Oper Orthop Traumatol. 2026, 38(5), 274-289. CC BY 4.0.
Gray’s Anatomy illustration of the medial elbow ligaments
Left elbow joint from the front and medial side, showing the ligaments around the medial epicondyle. The ulnar nerve runs behind the medial epicondyle. Image by Henry Vandyke Carter, Gray’s Anatomy (1918), Wikimedia Commons, public domain.

Indications

  • ORIF
    • Coronoid process
    • Medial condyle & epicondyle

Contraindications

  • Exploration of elbow
  • Access to lateral side

Position

  • Supine
  • Arm board
    • Shoulder fully ER
    • Elbow flexed to 90°
  • Prep & drape arm free

Landmarks

  • Medial epicondyle

Incision

  • 10 cm longitudinal incision centred over medial epicondyle

Internervous Plane

Superficial Dissection

  • Locate ulnar nerve
    • Mobilise & hold free with vascular tape
  • Identify & develop the plane between pronator teres & brachialis
    • Being careful not to damage the median nerve anteriorly
    • Gently retract pronator teres medially

Deep Dissection

  • Ensure the ulnar nerve is protected
  • Osteotomy of medial epicondyle
  • This exposes the joint capsule

Dangers

  • Nerves
    • Ulnar
    • Median

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