Introduction: Multiple treatment options have been recommended for management of neglected lateral condyle humerus fracture. A controversial topic is whether these injuries requires bone graft for osteosynthesis or not. This study compares the clinico-radiological outcomes and complications of neglected lateral condyle humerus fracture treated by open reduction with or without bone grafting after a minimum of twelve months follow-up. Material and Methods: A retrospective review of children aged less than or equal to 16 years with neglected lateral condyle humerus fracture presented after 4 weeks of initial trauma was done from January 2017 to December 2020. Patients were divided into two groups. Group A included children who underwent bone grafting, in addition to open functional reduction or open in-situ fixation, while Group B included patients who were managed without bone grafting. Result: Eighteen children were included (11 male, 7 female) in this review. Eleven patients were included in group A, while seven patients were included in group B. The mean age of patients in group A was 10.2 ± 3.9 years (range 5-16y) which was comparable with patients in group B (7 ± 3.5 years) . According to Hardacre criteria in both the groups at the last follow-up, in group A, 7 patients (63.63%) had excellent results, 2 (18.18%) had good, and 2 (18.18%) had a bad outcome. In group B, 4 patients (57.14%) had excellent results, 2 (28.57%) had good, and 1 (14.28%) had a bad outcome. Conclusion: Both in-situ fixation and open functional reduction are acceptable, but ORIF yields excellent results. Bone grafting after osteosynthesis is not essential. Osteosynthesis in situ could provide a solid bony union and improve elbow function without bone grafts. Level of Evidence: Level IV