Good results have been described for lateral condyle fractures treated by open reduction and fixation using Kirschner wires or screws. We, in our level III retrospective comparison clinical research study, retrospectively reviewed 84 patients (43 K-wire, 41 screw fixation; average age 5.6 years, average follow-up 6.8 months). With K-wires there were three nonunions (average time to union 9.6 weeks). With screws, all fractures healed (average of 7.8 weeks). Screw fixation patients spent fewer days in a cast and had a greater range of motion at the last follow-up. Screw fixation is associated with fewer nonunions and faster time to union, but a secondary procedure for removal is required.