Open reduction and internal fixation of pediatric medial epicondyle fractures can be performed safely utilizing screw (with or without washer), k-wire, or suture anchor fixation. The ability to appreciate how and when to employ these different fixation methods will facilitate management of the patient. There are a variety of reduction techniques that can present the fracture fragment into your incision and maintain the reduction during fixation. Careful observation of the placement of the incision and protecting the ulnar nerve are paramount to the success achievable with fixation and ultimate healing of this fracture fragment.