Background <p>Gartland type II supracondylar humeral fractures are common pediatric injuries with management strategies ranging from nonoperative casting to operative fixation with percutaneous pinning. Despite their frequency, the optimal treatment remains debated.</p> Methods <p>A comprehensive search was conducted in PubMed, Scopus, Cochrane Library, and Google Scholar from inception through December 2025. Eleven studies comprising 1947 patients (1249 nonoperative and 698 operative) met the inclusion criteria. Primary outcomes included carrying angle deviation, Baumann angle, Flynn’s criteria, elbow flexion range of motion (ROM), Mayo Elbow Performance Score (MEPS), QuickDASH, and overall complication rate.</p> Results <p>Operative fixation achieved slightly improved carrying angle deviation and greater elbow flexion compared with nonoperative management. No significant differences were found in Baumann angle, Flynn’s criteria, or MEPS. Operative treatment was associated with worse QuickDASH scores. Nonoperative management demonstrated a significantly lower overall complication rate, with notably fewer infections.</p> Conclusion <p>Both operative and nonoperative management provide satisfactory outcomes in type II pediatric supracondylar humeral fractures. While operative fixation yields small improvements in alignment and elbow flexion, these differences are not clinically meaningful and come at the cost of higher complication rates. Nonoperative treatment, with careful patient selection and close follow-up, remains a safe and effective option.</p> Level of Evidence <p>Level II.</p>