Elbow arthroscopy has advanced in recent years, expanding its applications in managing acute elbow fractures. Notably, it’s valuable for addressing diverse intra-articular and peri-articular fractures, including fracture dislocations. Benefits include better visibility, less tissue damage allowing early mobilization to prevent stiffness. Arthroscopy provides a comprehensive view, aiding in identifying and treating concurrent injuries like cartilage damage ligament in juries. It is also useful in pediatric cases in aiding adequate reduction. However, complications such as infections and nerve issues have been reported at rates up to 12%. A strong grasp of elbow anatomy and arthroscopic proficiency is crucial. Learning curves are expected, and conversion to open surgery might be necessary. This chapter covers techniques for fractures of the radial head, coronoid, lateral condyle in pediatric cases, capitellum, and distal humerus coronal shear fractures.