The surgical approach for distal humeral fractures is in most cases a posterior median incision with a straight posterior longitudinal incision centered on the fracture line. The skin, superficial fascia, and deep fascia are incised to reveal the triceps tendon, which can be longitudinally retracted or osteotomized with an ulnar hawkbone to reveal the distal humeral fracture. If the fracture is more on the medial or lateral epicondyle, the incision can be expanded distally to increase the exposed portion. If an ulnar hawk osteotomy is performed, the fracture site can be very clearly exposed and can be securely fixed with an appropriate internal fixation.