A case of neglected elbow dislocation having a late open reduction is presented and the literature reviewed. While the functional result is inversely related to the interval between injury and the time of operation, stability and early motion are two keys for good functional recovery. A new method of coronoid process reconstruction is presented as a suggestion for augmentation of elbow stability in patients with irreducible dislocation and stage III instability. A functional range of motion is achieved under immediate protected flexion-extension exercise after concentric reduction and secure reconstruction.