Five randomized controlled trials including 335 adult patients with severe polytrauma and femoral fractures were included in this systematic review and meta-analysis comparing early definitive stabilization versus delayed stabilization, and early total care (ETC) with intramedullary nailing versus damage control orthopedics (DCO) using external fixation. Pooled outcomes of interest included overall mortality, ICU admission, ICU and hospital length of stay, and duration of invasive mechanical ventilation. While early stabilization showed favorable trends, no statistically significant difference in mortality was observed. ETC with intramedullary nailing significantly reduced ICU stay and duration of mechanical ventilation compared to DCO. These findings suggest that early surgical intervention, particularly with ETC strategies, may offer improved outcomes in stable polytrauma patients.