When closed elbow dislocation results in brachial artery injury, concomitant median nerve dysfunction often results because of anatomic proximity. In the absence of median nerve paresthesia or palsy, however, a pink hand may erroneously suggest that vascular injury has not occurred. In such cases, inadequate clinical assessment of hand perfusion may delay diagnosis of vascular injury and result in serious complication. We report a case of closed elbow dislocation that resulted in brachial artery rupture without median nerve symptoms or loss of perfusion to the hand. We underscore the importance of appropriate vascular assessment and describe surgical treatment.