PURPOSE: To analyze the results of open reduction in displaced supracondylar fractures of the humerus in children, and to propose guidelines for an open approach to supracondylar fractures. MATERIALS AND METHODS: Twenty-six children(average age 6.7 years), who had open reduction of severely displaced supracondylar fractures were reviewes retrospectively over a 2- year period(1993 to 1997). Elbow range of motion, carrying angle, and radiographic measurement of the Baumann angle were assessed, then each distal humerus were compared to uninjured side. RESULTS: At follow-up, the Baumann angle and carrying angle differed by an average of 2 degrees and 4 degrees respectively compared with the unaffected arm. Range of motion was satisfactory in 96% of patientl, and there wah no significant cubitus varus. CONCLUSIONS: Open reduction of severely displaced supracondylar fractures is a safe and effective procedure, for which orthopedists should lower their threshold, given certain appropriate indicators.