SummaryMost fractures occurring before skeletal maturity can be treated with closed methods. However, some fractures may yield an unacceptable result if treated closed, such as fractures that cannot be reduced anatomically by these techniques, fractures that may not remodel, pathologic fractures, and fractures that require prolonged immobilization in a cast or traction. For such fractures, the Ilizarov external fixation method offers a minimally invasive method that allows function, provides immobilization, and aids reduction. The technique for treatment of femoral and humeral fractures requires careful preoperative planning, intraoperative technique, and postoperative follow-up.