Medial epicondyle fractures are often sustained with a valgus load applied to an extended elbow. The forearm flexors and medial collateral ligament can play a role in displacing the fragment, especially in the event of an elbow dislocation. Surgical treatment of medial epicondyle fractures aims for the restoration of the medial elbow osseous, muscular, and ligamentous anatomy, with the desired outcomes of obtaining a stable elbow with full range of motion and normal strength. In this paper, we discuss techniques for open reduction and internal fixation of displaced medial epicondyle fractures. We will discuss indications, preoperative planning, patient positioning, surgical technique, and postoperative protocols.