In patients with defect bone growth and dwarfism, fractures of the weight bearing skeleton are relatively rare due to their reduced mobility. When they do occur, their treatment and potential surgery are complicated. The commonly used therapeutic procedures are not applicable, the available implants are not suitable, if a surgery is necessary. An individual approach and often times also improvisation is needed. It is important to realize that these patients do not suffer from an intellectual disability and are fully aware of their physical impairment, which we must not make worse without an effort for adequate treatment. This case study presents our solution of a supracondylar femoral fracture in a patient with achondroplasia and extreme obesity. A proximal humeral nail was used for distal femoral fracture osteosynthesis by a retrograde approach. To the knowledge of authors, this study reports on the first case of supracondylar femoral fracture surgery in patients with achondroplasia. Key words: achondroplasia, dwarfism, supracondylar femoral fracture, extreme obesity.