Background: K-wire osteosynthesis is a widely used, cost-effective technique for stabilizing pediatric and adolescent fractures. The beneficial effect of perioperative antibiotic prophylaxis (PAP) and burying the K-wires below skin level to reduce infectious complications is still controversial. The goal of this study was to evaluate if the omission of PAP and leaving K-wires unburied affected the complication rate. Materials and Methods: A retrospective analysis of pediatric and adolescent K-wire osteosyntheses over a period of 11 years was performed. Records were screened for general, infectious and implant-associated complications. Follow-up was performed until the implant was removed. Results: Between January 2014 and December 2024 a total of 1022 K-wire osteosyntheses were performed and 779 were eligible for this study. Median follow-up to implant removal was 30 days [28–36 days]. At least one complication was documented in 17.6% (137/779) of the cases. Infectious complications were low at 2.6%—including 11 (1.4%) wound healing disorders and 9 (1.2%) pin site infections—and did not show difference regardless of application of PAP. No cases of osteomyelitis were observed until follow-up. Furthermore, implant-associated complications were more frequent with buried wires (10.2%; 19/187) than with unburied wires (3.4%, 20/592). Conclusions: Omitting perioperative antibiotic prophylaxis and leaving K-wires unburied in pediatric and adolescent patients undergoing closed reduction and K-wire fixation of distal radial and distal humeral fractures does not seem to increase the risk for infectious complications. Furthermore, unburied K-wires can be removed without the need for a second general anesthesia. Level of Evidence: III (retrospective cohort study).