Background <p>Various techniques for fixation of pediatric supracondylar humerus fracture have been in practice, but which is a better option is still controversial.</p> Purpose<i> of study</i> <p>There is a varied consensus on the outcome of fracture fixation based on different pinning methods. Hence, this study aims to compare the functional and radiological outcomes of pediatric supracondylar humerus fracture fixed by percutaneous cross-pinning or lateral pinning.</p> Methodology <p>We conducted a prospective, single-blinded, randomized control trial with 60 patients divided into two groups of 30 each, ages ranging from less than one year to 13&#xa0;years, with Gartland type 2 or 3 supracondylar humerus fractures. The outcome of fracture fixation treated with either crossed or lateral pinning was assessed with a six-month follow-up by comparing the pre-operative and post-operative Baumann angle, post-operative carrying angle and the Flynn criteria.</p> Result <p>There was no significant difference in the radiological outcome of the supracondylar humerus fracture fixed with percutaneous cross-pinning or lateral pinning. No patient had any iatrogenic ulnar nerve injury. All 60 patients had excellent Flynn criteria at the end of the six-month follow-up.</p> Conclusion <p>Both the techniques of percutaneous pinning showed comparable bony union. However, lateral pinning had better functional outcomes due to minimal stiffness and a good range of movements at four weeks. The iatrogenic ulnar nerve injury seen commonly in cross-pinning could be avoided with a 1&#xa0;cm skin incision over the medial condyle to visualize the ulnar nerve and the medial kirschner wire entry made anteriorly.</p> Clinical trial registry-india registration number <p>CTRI202404066233</p> Graphic abstract <p></p>