Background: Comminuted fracture femur with bone loss is a high energy injury with variable clinical and radiological scenarios; therefore, management has been a challenge to Orthopaedic surgeons because of associated complications and absence of standard guidelines to organize the different treatment options. The aim of the work is to assess radiological and functional results of managing comminuted fracture femur with bone loss by mono lateral external fixator, study the technique of application and related complication. Methods: This retrospective case series study was done in May 2010 to December 2016 with mean follow up period 1.5 years and included 21 patients who were divided into two main groups, group (I) included 11 patients managed by acute shortening and distraction, and the group (II) included 10 patients managed by bone transport technique. Outcome in both groups was compared regarding time to union (external fixator time), length gained, healing index (external fixator time/length gained), bone results and functional results according to Paley. Complications in both groups have been compared and classified according to Paley into 3 categories: problems, obstacles, and sequelae.