Hinged external fixation of the elbow joint can play an important role in managing complicated fracture-dislocations, joint instability after extensive contracture release, and distraction interposition arthroplasty. Application of these devices requires accurate alignment of the fixator axis with the anatomic axis of the elbow. The primary therapeutic goal is to allow joint motion while protecting the healing ligaments. Common complications include pin loosening, injury to adjacent neurovascular structures, cellulitis, and loss of reduction. Although reported data are limited, this technique is a useful adjunct in patients with complex elbow instability.