This chapter discusses the open management of post-traumatic stiff elbow including classifications of elbow stiffness, the aetiology and pathophysiology of post-traumatic stiff elbow (including soft-tissue contracture, heterotopic ossification, fracture malunion/non-union and joint arthrosis) and clinical evaluation and diagnosis. Non-operative management options are detailed, including static progressive and dynamic splinting, serial casting, manipulation under anaesthesia and physiotherapy. Operative interventions are outlined, including open arthrolysis and mechanical distraction, focusing on different surgical approaches (posterior, lateral, medial and combined). Specific surgical techniques, like the Outerbridge–Kashiwagi procedure and lateral column approach, are described in detail. Postoperative management, potential complications and future research directions are described. The authors emphasise a multidisciplinary approach involving surgeons, physiotherapists and pain teams for successful outcomes.