Four cases of arterial injury complicating posterior dislocation of the elbow are described. All of these patients were treated by emergent revascularization; reconstruction of the soft-tissue constraints of the elbow joint was performed by using osseous suture anchors. Despite prompt treatment of the vascular injury and successful restoration of elbow articulation and stability, all of the patients had residual functional disability. The previous literature has not discussed the functional results of these reconstructions. This report underscores the severity of these injuries, details our reconstructive strategy, and analyzes the functional outcome of these badly traumatized extremities.