The use of total elbow arthroplasty is demonstrated for a comminuted distal humerus fracture in an elderly patient. Case presentation and general information regarding total elbow arthroplasty including operative indications/contraindications and benefits/risks are presented. The procedure is reviewed in a step-by-step manner addressing potential pitfalls and providing surgical pearls. A short literature review is provided, regarding the historical outcomes of this surgery in this population.