Background: Intra articular elbow fractures are considered to be one of the most complex injuries in orthopedic trauma. Some are too comminuted for open reduction and internal fixation. Recently total elbow replacement (TER) had gained popularity for the treatment of comminuted elbow trauma when other treatment options are not possible. Methods: Since 2007-2013 we treated 18 patients with TER due to comminuted distal humeral fractures. We used the Disabilities of the Arm, Shoulder and Hand scoring system (DASH) to evaluate the patient’s satisfaction. In addition, we evaluated the elbow range of motion and collateral stability. Results and Conclusions: Functional range of motion was achieved with high patient’s satisfaction. Based on the results, we conclude that TER is a reasonable option for complex elbow fractures when open reduction and internal fixation is not suitable.