Purpose: Open comminuted intraarticular distal femur fracture represents a formidable challenge for the orthopaedic surgeon for the inherent fracture complexity, soft tissue damage, and contamination. The purpose of this study was to evaluate the mid-term outcome results and safety of using the Ilizarov fixator to treat these fractures. Patients and Methods: The study included 22 fractures treated by debridement with reduction and stabi- lization by Ilizarov external fixator. The mean age was 35 years. Gustilo grade of open fracture was III-A (19 cases), III-B (2 cases), and III-C (1 case). Six fractures were AO-OTA type 33C2, and 16 cases were type 33C3. Eight patients had associated injuries. Bone and functional results were evaluated by Associ- ation for the Study and Application of the Method of Ilizarov (ASAMI) criteria, and Neer knee score. The statistical analysis was done using the IBM SPSS Statistics for Windows. Results: Seven cases had autogenous bone grafting. The frame crossed the knee in 8 patients. The fixator was removed after a mean of 7 months with union in all cases, and without any malalignment > 5 °. Deep infection occurred in two cases. Quadriceps-plasty was needed for 3 cases. After a mean of 44 months, the last follow-up results showed full knee extension and a mean flexion of 107.59 °. The ASAMI functional and bone results were good to excellent in all cases. Neer knee score averaged 86.59. Conclusions: Ilizarov fixator was an effective treatment modality of open comminuted distal femur frac- tures with high union rate, adequate alignment and satisfactory functional outcomes