Displaced extension type supracondylar fractures of the humerus are associated with neurovascular injuries and malunion (cubitus varus). Reduction is not usually difficult during the first few hours, but it is a problem to maintain. After reduction, the shoulder is placed in abduction external-rotation with the elbow flexed under the C-arm. This position locks the proximal segment of the fracture, and the posteromedially rotated distal segment can then be brought back into an anatomic position under the “medial pillar.” In this position, an excellent lateral view is obtained and the “fish tail” deformation can be corrected. Crossed percutaneous K-wires are introduced to maintain reduction. An anteroposterior radiograph can then be freely obtained, and there is no need for hyperflexion at the elbow. Twenty-six children were treated between 1987 and 1992. Excellent results were obtained.