It is extremely difficult to treat to the type III open fractures of the tibial shaft which have been severely comminuted and splitted in the long length. Early internal fixation with plates and screws or intramedullary nailing of type III open fracture is contraindicated because of high infection rate and circulatory compromising at the fracture site. External fixation is the method of choice for the treatment of type III open fracture of the tibia. It reduces the risk of infection and permits easy access for wound care, early mobilization of joints and weight bearing.

Four type III open fractures of the tibial shaft that were very unstable had entered this hospital from November 1990 to June 1992. The patients were all young males. The causes of injury were one explosion and three motor vehicle accidents. The open fractures were three type III A and one type III B according to Gustilos classification. These fractures were stabilized with Ilizarov external fixator. Parenteral antibiotic therapy was started from the emergency room to prevent infection.

Illzarov fixator was applied 17 to 63 days(av. 37 days) after injury and maintained for 6 to 12 months(av. 8 months). Subsequent autogenous bone grafting and internal fixation were done in three patients 7 to 8 months after external fixation because of delayed union. Follow-up period ranged from 1 year and 11 months to 2 years and 6 months(av. 2 years and 2 months). Solid union was obtained in all patients between 1 year 1 month and 1 year and 7 months(av, 1 year and 3 months) without active osteomyelitis.

At last follow-up, there were mild limitation of ankle joint motion in all patients and tibial shortening of 18 to 34mm(av. 25 mm)on the roentgenograms of three patients. No significant working disability or malalignment of the leg was noted in all patients. The final results were very good compared to the severity of their injuries.