Previous studies have found a wide range of perioperative complications associated with distal humerus osteotomies for malunion of supracondylar fractures in children. Our hypothesis was that the surgery would have few perioperative complications when performed at a pediatric center. We examined perioperative complications of corrective osteotomy for malunited supracondylar humerus fractures in 41 patients treated at Childrens Hospital Los Angeles between 1987 and 2002, and we established the risk factors associated with these complications. The overall complication rate was 32% (13/41). In the early surgeries, performed between 1987 and 1997, the complication rate was 53% (10/19); 6 (32%) of the 19 patients required reoperation. In the later surgeries performed during 1998 and 2002, the complication rate was 14% (3/22); no patient required reoperation. The complication rate was significantly lower (P = .0005) when lateral-entry pins were used to fix the osteotomy (13% [2/15]) than when other fixation methods were used (42% [11/26]). Using current techniques and performing the surgery in a pediatric center, we report a 0% reoperation rate and a 14% complication rate in distal humerus osteotomies for surgeries performed after 1997, a rate that we believe is acceptable. Furthermore, there are fewer complications of the surgery when lateral-entry pins are used to fix the osteotomy compared with other fixation methods.