Posterior elbow dislocation is rarely associated with brachial arterial injury, occurring in two of 23 patients. A cool pulseless hypesthetic arm associated with swelling at the elbow after a history of a fall on an outstretched arm indicates arterial injury associated with posterior elbow dislocation. Concomitant neurologic and bone injury may occur as well. Arterial repair and stabilization of the elbow is the treatment of choice and should result in a functional extremity.