Recognition of the important role of the coronoid process to the stability of the elbow has contributed to a greater interest in internal fixation of coronoid fractures. Large fractures are usually associated with olecranon fracture-dislocations and smaller fractures with terrible triad injuries or lateral collateral ligament injury (varus posteromedial rotatory instability). Large fractures can often be visualized and realigned through the olecranon that cannot be addressed through the olecranon fracture alone. All of the approaches are made through a midline posterior skin incision. Anteromedial facet fractures (common among varus posteromedial rotatory instability and posterior Monteggia injuries) may be best treated with a small anterior plate applied through the medial exposure.