Background This study describes a posterior approach to the elbow for placement of a total elbow prosthesis. Methods Release of the medial collateral ligament is achieved by performing an osteotomy of the medial epicondyle. This allows anatomic refixation of the origin of the medial collateral ligament. A description of the posterior approach is given. Standard radiographs were used to analyze the bone-to-bone refixation of the osteotomy of the medial epicondyle in 13 elbows. Results Radiographs showed proper bone healing in all elbows, with restoration of the anatomic origin of the medial collateral ligament. Discussion The described approach provides a good exposure of the elbow necessary for the placement of modern total elbow prostheses, without compromising the stability of the elbow. Refixation of stabilizing structures is relatively easy and results in an anatomic position of the ligaments.