Supracondylar fractures of the femur, particularly those with intracondylar extension, represent some of the most challenging fractures. They do almost universally poorly when treated nonoperatively but do even less well when operated on using inadequate technique.We use the AO technique and supracondylar blade plate for fixation of these fractures. The standard technique and instruments are well described in the AO manual and are not repeated here.Preoperative preparation is directed at assessing and managing the fracture and the associated injuries which these patients often have. Management of the fracture requires the assembly of adequate x-rays, equipment, and personnel.In all these fractures the key to good reduction and fixation is excellent placement of the blade in the condyles. In fractures with intracondylar extension the condyles must be reconstructed and rigidly fixed first. In those fractures with bone loss, excellent placement of the blade allows the plate to act as guide to both alignment and rotation.With good reduction and stable fixation of their fractures, these patients do well even if they have quite comminuted fractures.