Distal humeral fractures are injuries worldwide with operative fixation being the preferred method of treatment. Ulnar neuropathy is one of the possible complications of surgery, and may require an additional surgery to achieve symptom resolution. In this video, Dr. Agarwal-Harding manages a patient who was previously treated with open reduction and internal fixation of a distal humerus fracture, but his recovery was complicated by ulnar neuropathy. He performs an ulnar neurolysis, hardware removal from the medial column of the distal humerus, and anterior transposition of the ulnar nerve with an adipofascial flap. Surgical considerations, including rationale and treatment options, are discussed.