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Treatment of supracondylar femur fractures in myelopathic, nonambulatory patients has traditionally been nonoperative, emphasizing careful skin protection, limited mobilization, and acceptance of malunion. This study compares the results of surgical treatment with nonsurgical treatment in this patient population. The records of all myelopathic, nonambulatory patients treated for supracondylar femur fractures (OTA code 33) between 2001 and 2006 were reviewed: 25 patients (29 fractures) were discovered (11 women, 14 men; average age, 51 years). Surgical treatment was performed in 17 fractures (13 retrograde intramedullary rods and 4 plates) and nonsurgical treatment in 12 fractures. Union was obtained in all operatively treated fractures and in 90% of nonsurgically treated fractures. Average follow-up was 16 months. One patient treated with a retrograde nail sustained a nondisplaced intertrochanteric hip fracture treated nonoperatively. One patient treated operatively developed a late deep infection. There were no other surgical-related complications. Skin or wound complications developed in no patients treated surgically and in 4 patients treated nonsurgically (P= .0208). Three patients with nonoperatively treated fractures required eventual surgery (3 above-knee amputations). Operative treatment of femoral fractures in nonambulatory patients with myelop-athy is safe and effective. There were fewer skin and wound complications in the surgically treated supracondylar femur fractures.