Fractures or dislocations secondary to blunt trauma causing vascular injury is rare. The upper extremity is least often affected. Early diagnosis is largely based on the clinical findings of absent pulses, cyanosis, hematoma, or other signs of arterial ischemia. However, in few cases, late manifestations such as arteriovenous fistulae (AVF) and false aneurysms develop. Chronic AVF’s can lead to complications of hyperdynamic congestive heart failure, proximal arterial dilatation, and possibly endocarditis. We present the case of a 60 year old man with a chronic giant AVF of the upper extremity following a distal radius fracture at age 12. The AVF enlarged over a period of almost 50 years in which several surgical ligations were attempted. Eventually, the AVF compressed multiple tendons and nerves in the forearm and extended proximal the elbow. Due to the size of the AVF and its involvement with other structures, embolization and resection became impossible. Thus, a below-elbow amputation was performed. This radical treatment of a benign lesion illustrates the need for early diagnosis and early treatment by surgical repair or embolization. Other complications that may also be prevented by early diagnosis and treatment include congestive heart failure, proximal arterial dilatation, and possibly endocarditis.