Mr. Basam, from Yemen came to Sakra Premium Clinic with a gunshot injury in his elbow. He had lost a lot of vital structure around the elbow and had undergone multiple surgeries for the same in his own country. Even though his limb was saved as result of all these surgeries he was still not able to perform simple activities of daily living. He could not comb, eat, write or simply lift his arm properly. The main problem was the severely bones and there was literally no joint making the elbow the arm dangling. There was no hold between the upper and lower part of the limb. It was a very challenging case because when he came to us, his joint was moving in all possible directions. The patient was very keen on getting the treatment, and was eager to get back to normal as it was the dominant hand and he felt handicapped. We evaluated the patient and did multiple investigations and a CT scan with 3D reconstructions to understand the remaining bone structure and to evaluate what best could be done with it. There were multiple challenges – like the normal anatomy of the hand had been distorted due to the injury and the multiple surgeries. Also the bone structure was completely damaged and disorganized, the skin over injured part was not in a very good condition and another major concern was the musculature and its functionality after the surgery. So after evaluating and thorough investigations, we decided to perform the surgery. We explained the details of the surgery to the patient, told him about all the limitations the pros and cons of the surgery along with the precautions he would need to take. The patient was also very enthusiastic and showed great enthusiasm and willingness to follow all the precautions. Finally we were able to perform a successful Total Elbow Arthroplasty, with complete wound coverage followed by good healing. After 3 weeks we removed the plaster and started mobilizing the joint and he showed excellent improvement. The recovery was very good, he could move and use his arm comfortably and could even write. Seeing the happiness on the patient’s face and his ability to use his arm again makes it indeed a very satisfying job.