Success in elbow surgery depends on a thorough understanding of its anatomy and the access to its various compartments and components.This article has reviewed the current applied surgical anatomy of the elbow and the related surgical approaches. For acute elbow injuries the Global approach is preferred, because this incorporates a posterior skin incision to expose the medial and lateral sides of the joint. The "Z"arthrotomy algorithm avoids PLRI when exposing the lateral joint capsule. The acute distal biceps tendon avulsion can be repaired with a minimally invasive anterior approach.