Twenty-three fractures of the distal femur were treated by open reduction and internal fixation with a compression screw device. Eleven to 34 months of clinical and radiographic follow-up evaluation was available in 19 patients. No nonunions or implant failures and only one deep wound infection occurred. Excellent or good functional and radiographic results were achieved in 74% of patients. Fair results were noted in 16% of patients, and results in 10% were considered failures. The technique is readily mastered and analogous to use of the hip compression screw.