Background <p>This study aims to introduce a surgical technique using percutaneous Kirschner wire fixation for pediatric supracondylar humeral fractures with medial column impaction.</p> Methods <p>A retrospective analysis was conducted on 46 patients diagnosed with supracondylar humeral fractures with medial column impaction who underwent treatment at a children’s hospital, from January 2022 to January 2024. Among these patients, 20 received percutaneous K-wire fixation, while 26 underwent conservative treatment. Fracture healing time and complications were recorded. The carrying angle (CA) and Baumann angle (BA) of the affected elbow joint were assessed preoperatively, immediately after surgery, and at 3 months postoperatively. Elbow range of motion was measured and compared at the final follow-up. Additionally, elbow function was evaluated using Mayo Elbow Performance Score (MEPS).</p> Results <p>All 46 patients completed follow-up, with durations ranging from 4 to 10 months. Fracture healing times were similar between the two groups, averaging 27.60 ± 1.85 days in surgical group and 27.85 ± 2.33 days in conservative treatment group. Postoperative complication rates were 5% and 7.7%, respectively. No statistically significant difference in the preoperative BA (<i>P</i> &gt; 0.05). However, significant differences were observed in terms of immediate postoperative BA, BA at 3-month follow-up, and CA at 3-month follow-up(<i>P</i> &lt; 0.05). At the final follow-up, elbow joint range of motion was similar( <i>P</i> &gt; 0.01). However, MEPS demonstrated significantly better functional outcomes in the surgical group ( <i>P</i> &lt; 0.05).</p> Conclusion <p>Percutaneous Kirschner wire fixation is effective in treating this distinctive fracture subtype, providing superior radiographic alignment and comparable cosmetic outcomes.</p>