We report the outcome of conservative and surgical management in 50 skeletally mature patients (average age 64.6 years, 36 females patients) with 51 supracondylar femoral fractures treated in our unit between June 1991 and December 1993. Thirty-six fractures were caused by low-energy trauma, and 15 were due to high-energy trauma. Open fractures occurred in 5 patients. Of the 34 patients (35 fractures) treated conservatively, 15 (46%) achieved a satisfactory result. Of the 16 patients treated by internal fixation, 10 (62%) reached a satisfactory outcome. Osteoporosis, severe comminution of the fracture, involvement of the knee joint, and soft tissue injury in open fractures were associated with unsatisfactory results. Conservative management of these fractures is associated with a lesser chance of achieving a good functional result. With the advent of new fixation devices and our experience that conservative management can actually lead to many complications, the proportion of patients operated upon is likely to increase.