The clinical findings and pathological anatomy of 110 fractures through the lower three inches of the femur are presented. A classification based upon the type of displacement (Fig. 1) was thought to be more descriptive of the problem than the terms supracondylar and dicondylar alone. Each category presented clinical characteristics which are described. Seventy-seven fractures were followed for from one year to twenty-four years after injury. The results, graded by a numerical rating system, are considered according to anatomical classification. The results in patients treated by internal fixation are compared with those in patients treated by closed methods. No category of fracture at this level seemed well suited for internal fixation, and sufficient fixation to eliminate the need for external support or to shorten convalescence was rarely attained. The majority of serious local complications occurred after this form of treatment and, of twenty-nine patients so treated and evaluated, only 52 per cent obtained a satisfactory rating. Closed treatment yielded satisfactory results in 90 per cent of the forty-eight patients evaluated and in 84 per cent of those with displaced supracondylar fractures. Functional recovery was slow in patients with Group II-A and Group III injuries. Common errors in the management of tibial traction, noted during this study, supplemented by laboratory and cineroentgenographic observations, are discussed.