Post-traumatic elbow arthropathy is a challenging pathology for the upper extremity surgeon to manage. While arthroplasty is a powerful tool for the mnagement of degenerative elbow conditions, it remains optimized for the lower demand, elderly patients due to high revision and complication rates in younger patients or those with post-traumatic pathology. In the younger patient, early post-traumatic symptoms can be managed with joint preserving techniques, however, as disease progresses, joint sacrificing procedures may be required. Unfortunately, there is limited strong evidence to guide treatment; however, careful patient centered discussion and treatment selection can produce successful outcomes.