This is a review of a unique group of 12 children with lateral condyle fractures of the distal humerus with displacement of > 2 mm. Intraoperative arthrograms of each elbow demonstrated no articular incongruity associated with minimal rotation of the distal fracture fragment. After closed reduction the lateral condyle fractures were percutaneously pinned, obviating the need for open reduction and internal fixation. The results in this study group were uniformly excellent as based on the rating system of Hardcare. Each child had a normal range of elbow motion and all cases healed clinically and radiographically without complication. Previous literature has recommended that all lateral condyle fractures displaced > 2 mm be treated with open reduction and internal fixation. The authors feel that in selected cases of lateral condyle fractures with > 2 mm displacement and an arthrographically demonstrated congruent joint surface, percutaneous pinning may safely and effectively be performed.