Nonphyseal supracondylar fractures of the femur are considered to be uncommon in children and have received little attention in the literature. A retrospective review of femoral fractures in children at the authors' institution was undertaken to ascertain the incidence of supracondylar femoral fractures, the influence of associated musculoskeletal conditions, and pitfalls of management. In this study of 102 femoral fractures, there was an incidence of 12% of supracondylar fractures. Four of 12 patients had a significant predisposing musculoskeletal condition contributing to the genesis of the fracture. Five fractures were undisplaced and easily managed. Seven displaced fractures required intervention to achieve an adequate reduction. The literature is reviewed and a classification system for these fractures is presented. Treatment options are discussed and recommendations made based on this experience.