The surgical approach for open reduction and internal fixation of lateral condyle fractures in children is controversial. Some authors recommend the lateral approach to the elbow over the posterior approach because of theoretical concern for injury to the vascular supply of the distal humerus and potential avascular necrosis (AVN). The purpose of this retrospective case series study is to report the outcomes of open reduction and internal fixation of displaced lateral condyle fractures of the humerus by the posterior approach. Fifteen consecutive cases were reviewed and the posterior approach resulted in minimal postoperative loss of motion, no angular deformity, cosmetic scars, and no AVN. We support that AVN occurs because of stripping of soft tissues from the lateral condyle fragment and not the approach used. Stripping of soft tissues is not required when using the posterior approach because of excellent visualization of the fracture reduction.