The authors describe a case with a closed posterior elbow dislocation associated with a distal radial fracture and complete transsection of the brachial artery. The patient had a pulseless distal upper extremity and immediate gross swelling of the elbow and forearm. As closed reduction was not possible, open reduction had to be performed through an anteromedial approach to the elbow. End-to-end suture of the brachial artery was successful. After fasciotomy and internal fixation of the distal radial fracture, the elbow was stabilized with an external fixator spanning the elbow joint. After two years, despite good function of the elbow, restoration of the hand function is not optimal owing to persistent motor deficit of the ulnar nerve.