Purpose <p>Supracondylar humeral fractures are common in children and require early surgical intervention to prevent complications. Although percutaneous pinning is a standard treatment, the optimal pinning technique remains controversial. Therefore, this study aimed to compare the outcomes of lateral and through-the-elbow joint pinning (group J) and cross-pinning (group C) for paediatric supracondylar humeral fractures.</p> Methods <p>This retrospective analysis included paediatric patients with supracondylar humeral fractures treated at two trauma centres. Group J underwent lateral and through-the-elbow joint pinning, whereas group C underwent cross-pinning. Clinical data, including demographics, surgical details, complications, and radiological assessments, were collected and compared between the groups.</p> Results <p>Both groups exhibited similar demographic and clinical characteristics, except for the timing of post-operative Kirschner wire removal. No significant differences were found in elbow range of motion or the incidence of complications between groups J and C. Radiologically, there were no significant differences in fracture union or reduction loss between the groups, although group C showed larger Baumann and tilting angles than group J.</p> Conclusions <p>Lateral and through-the-elbow joint pinning demonstrated outcomes comparable to those of cross-pinning in paediatric supracondylar humeral fractures. Both techniques resulted in minimal reduction loss, with no cases of ulnar nerve palsy. These findings suggest that lateral and through-the-elbow joint pinning is a viable alternative to cross-pinning, potentially reducing the risk of iatrogenic ulnar nerve injury.</p>