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The current case report describes a complex Monteggia variant fracture dislocation in which a radial head autograft was used to create a stable construct for a 75% deficient coronoid segment. In this report we will provide details of the reconstruction technique, as well as information with regard to perioperative management, intraoperative findings, postoperative clinical progression, and subsequent postoperative imaging. Restoration of a fractured coronoid in the setting of Monteggia variant fractures is a technically challenging procedure. Our case demonstrates that using a radial head autograft to repair a severely fractured coronoid can lead to a successful outcome for the patient.