The charts of 77 severely handicapped institutionalized children and young adults were retrospectively reviewed to assess the incidence of femur fractures. No fractures occurred in ambulatory patients. Four of 37 nonambulatory patients who did not have hip surgery (10.9%) had sustained a fracture at some time during their life. Six of 21 (29%) nonambulatory patients who were operated on for subluxed or dislocated hips sustained a femur fracture within 3 months after discontinuation of their spica casts. This risk factor should be taken into account when one considers operation in severely affected nonambulant spastic quadriplegic patients.