The patient in this case was an otherwise healthy 6-year-old male who presented to the emergency room with a right elbow deformity from an injury sustained while playing football. He reported being tackled and falling back, leading to a direct impact onto his flexed right elbow. Examination demonstrated his right arm to be neurovascularly intact despite having a closed gross deformity at the elbow joint. X-ray evaluation revealed an anteromedial elbow dislocation with fracture of the radial head (Figure 1). Two attempts were made at closed reduction in the emergency room under ketamine sedation with no appreciable reduction or improvement in alignment. Given the lack of success with closed reduction, the decision was made to take the patient to the operating room urgently for closed versus open reduction and possible fixation. Once under general anesthesia and with muscle relaxation employed, another closed reduction maneuver was attempted again with no success (Figure 2). A direct posterior approach to the elbow was then performed with exposure carried around to the subcutaneous border of the ulna. It was noted that the olecranon apophysis remained in its anatomic position despite the ulna being anteriorly dislocated. Interestingly, the proximal ulna was found to be buttonholed through the anterior joint capsule, thus preventing reduction of the joint. The radial head was also noted to have an angulated Salter-Harris II fracture which was realigned with direct pressure application. No epicondylar fracture was noted with direct inspection. Once the entrapped proximal ulna was freed from the anterior capsule, it was easily reduced into its anatomic position (Figure 3). Braided suture was used to reattach the olecranon apophysis to the proximal ulna through two drill holes in a figure of eight fashion. Final clinical exam and fluoroscopy images through a full range of motion revealed stable reduction of both the elbow joint and olecranon apophysis. The patient was splinted for approximately four weeks followed by progression of gentle passive and active elbow range of motion. At his most recent 7-month follow-up, the patient was doing very well with 0o-135o of elbow extension and flexion and 75o each of forearm pronation and supination. Radiographs revealed well aligned and healed fractures with maintained physes (Figure 4).