A case of total elbow dislocation with significant swelling and loss of distal pulses during police arrest is described. To date, this specific injury in relation to police arrest has not been described in the literature. Whilst attempting to remove the detainee from a public transport vehicle, the patient and the officers involved fell to the ground with his arm slightly flexed. He was handcuffed to the rear and taken to the police office. Whilst there, it was noted that his left elbow was swelling dramatically and he complained of pain. The detainee and officers attended the emergency room and he was found to have a total dislocation of the left elbow and vascular compromise of the limb. The elbow was promptly reduced with sedation and a post reduction angiogram demonstrated injury to the tissues surrounding the brachial artery.