Aim: We report on the use of external þxation as an alternative þxation of femoral fractures in patients where internal þxation is a borderline indication. Patients and method: From 1991 to 2001, twenty-þve patients with femoral diaphysis fractures were treated by external þxation. Indications included candidates with multiple injuries and unstable general condition, open fractures IIIA, B, C, neglected open fractures with or without infection, comminuted shaft fractures, gunshut injuries and infections after internal þxation. The fractures were stabilized with a unilateral external þxation or with a special anti-varus frame. Results: In twenty patients, external þxation was the deþnitive method of stabilization, while in þve, it was a temporary method. The average time to union was 5 months. Complications included: pin tract infection, restricted knee motion, and loss of reduction. Conclusion: External þxation should not be routinely used for þxation of femoral fractures, but may be considered in multiply injured and critically ill patients. As in any method of þxation, the surgeon must be familiar with the device used, the mechanical and the application properties of such devices, and, most importantly, the postoperative management of the patient.