Supracondylar humeral fractures are the most common elbow fractures in children and represent 3 % of all paediatric fractures. The most common cause is a fall onto an outstretched hand with the elbow in extension, resulting in an extension-type fracture (97–99 % of cases). Currently, the Gartland classification is used, which has treatment implications. Diagnosis is based on plain radiographs, but accurate imaging could be limited due to patient pain. Based on fracture type, the definitive treatment could be either non-operative (type I) or operative (type III/IV); however, when handling type II fractures controversy remains. Neither pin configuration have shown higher efficacy over the other. Complications are ~1 %, the most common being pin migration, with compartment syndrome as the most devastating. Overall, functional outcomes are good, and physical therapy does not appear to be necessary.