BACKGROUND Polytrauma remains a major social, economic and medicine affliction. A successful surgical treatment of polytrauma patients requires an approach predicated on prioritizing injuries. An isolated femur fractures rarely poses any threat but in association with multiple injuries, this fracture assumes greater significance. The proper management of femur fractures in polytrauma can greatly reduce the mortality and morbidity. METHODS We present our results in the treatment of 24 femur shaft fracture in 22 polytrauma patients treated by Mitkovic external fixator in 5 year period (2000-2004) on Orthopeadic and Traumatology Clinic--Clinical Center Nis. The average of patients age was 32.8 years (ranging from 17 to 62). There were 11 (46%) closed and 13 (54%) open fractures. RESULTS Eighteen fractures were treated by external fixation until union. The remaining six fractures were treated by conversion of the external fixation to internal fixation. Sixteen fractures (88.88%), in which the external fixation was the definitive method of treatment, healed completely. The average healing time was 6.29 (4-9) months. There were three pin-track infections (16.66%), one nonunion (5.55%) and only one deep infection (5.55%). CONCLUSIONS The external fixation by the use of Mitkovic external fixator in the treatment of femur fractures is a safe procedure to achieve temporary rigid stabilisation in polytrauma patients before the subsequent internal fixation (damage control orthopaedics). The external fixation using Mitkovic external fixator can be definitive method of choice in treatment of open and comminutive femur fractures in polytrauma patients until union.