Purpose: To evaluate the effectiveness of illizarov external fixator in management of intertrochanteric fracture of femur in high risk patients. Methodology: 22 patients of chronic diseases with relative contraindication for closed reduction and internal fixation were managed by illizarov. There were 17 male patients (77.3%), and 5 females (27.7%), 12 patients had hepatic problems 54.5% , while 6 patients 27.3% had uncontrolled hypertension and cardiac problems , where 2 patients 9.1% had pulmonary diseases , while 2 patients 9.1% had diabetes mellitus. patients mean age was 65.5 years, range (30-81) years, fracture pattern was stable Evans type 1 in 17 patients 77.3%, while 5 patients 22.7% had unstable Evans type1 . Results: Follow up was 19 months after fracture healing, there were no mortalities in early or late postoperative period. In half of the patients , it was 90 days for fracture healing where in the other 50% , 120 days needed for complete union. Harris hip score used for evaluation of the outcome, the result was excellent in13 patients 59.1%, while good in 4 patients 18.2%, where fair in 4 patients 18.2%, and poor in 1 patient 4.5%. pin tract infection was in 100% of the patients (superficial type). Varus deformity in 3 patients 13.6%, while shortening was in 4 patients 18.2%, ranging from 1.2 cm to 1.8cm. Conclusion: Illizarov could be considered as an alternative treatment modality for high-risk patients with intertrochanteric fracture. Technique is simple, safe and can be performed under regional and even local anesthesia.