Background: Attempting limb reconstruction in the presence of critical bone loss usually involves surgery which had technically difficult, time-consuming, physically, and psychologically demanding for the case, with no guarantee of a satisfactory outcome. The function of the salvaged limb might be disappointing due to residual pain, joint stiffness, and neurovascular deficit. The case might require a secondary amputation due to refractory disease or non-union. Thus, the correct initial decision as to whether to embark upon limb reconstruction or to perform a primary amputation had important but difficult.
Objective: The aim of this essay had to evaluate various treatment options for open femoral fracture with bone loss regarding, different methods to compensate for bone loss, and the complications of each one.
Methods: PubMed, Google Scholar, and Science Direct were searched using the following keywords: Treatment of open femoral fracture, Bone loss, and Bone loss and complications. The authors also screened references from the relevant literature, including all the identified studies and reviews, only the most recent or complete study was included between June 2000 and December  2020. Documents in a language apart from English have been excluded as sources for interpretation were not found. Papers apart from main scientific studies had been excluded: documents unavailable as total written text, conversation, conference abstract papers, and dissertations.
Conclusion: Bone loss had a relatively uncommon problem encountered in the treatment of open fractures, and usually occurs in the femur and tibia. The majority of defects had small and could be managed with standard methods of fixation, and autogenous bone grafting. Larger defects with complex soft-tissue problems could be managed by shortening, fixation with later lengthening.