SummaryThe treatment of distal humeral fractures has evolved over the past several decades. Due to advances in surgical techniques, as well as internal fixation devices, open reduction and internal fixation for an adult distal humeral fracture is now the rule rather than the exception. As the number of operative cases increases, so does the number of postoperative complications. One complication that can occur is failure of the implanted device intended to provide stability to the fracture. Multiple causes including osteopenia, infection, comminution, and poor initial fixation have all been identified. Loss of fixation at the fracture site often leads ultimately to nonunion. The treatment of fixation failure in the elbow can be especially difficult as soft tissue problems frequently contribute to the dilemma. In an effort to achieve a stable, pain-free range of motion in the elbow, several different options exist for the practicing orthopedist who chooses to treat these challenging situations. Revision osteosynthesis with bone grafting, semiconstrained total elbow arthroplasty, arthrodesis, allograft reconstruction, and the “bag-of-bones” technique have all been described as ways to obtain a satisfactory outcome for both the patient and the treating orthopedist.