Surgical exposure of the elbow joint is technically demanding because of its complex ligamentous and neurovascular anatomy. With the increasing incidence of elbow trauma, various surgical approaches have been developed for the management of fractures and instability. The primary goal of any surgical approach is to provide safe access to the pathological area, achieve adequate visualization, and preserve the surrounding soft tissues. Lateral approaches are the most commonly used techniques, particularly for radial head pathologies, condylar fractures, and capsular releases. Medial approaches are mainly preferred for coronoid fractures and medial collateral ligament repairs. The anterior approach may be utilized for coronoid and trochlear pathologies or for exploration of the neurovascular bundle; however, it carries a higher risk of neurovascular injury. The posterior approach is considered a universal method because it allows broad visualization of the joint and is frequently used in distal humerus fractures and complex elbow surgeries. Although olecranon osteotomy provides the best visualization of the articular surface, it is associated with disadvantages such as nonunion and the potential need for implant removal. Therefore, the choice of surgical approach should be based on the specific pathology, anatomical requirements, and the surgeon`s experience.