The use of external fixation in open tibia fractures with severe soft tissue injury is the most preferred and safe treatment. The primary allograft application is doubtful due to high infection risk.

The evaluation of the results of open tibia fractures type II and III according Gustillo-Anderson that were treated with simultaneous external fixation and allograft application.

From 2005–2007, twenty nine open tibia shaft fractures in 27 patients (2 bilateral) with mean age of 35 years-old were treated.

According Gustillo-Anderson classification, there were 20 GII, 6GIIIa and 3GIIIb open tibia shaft fractures without severe bone loss. All patients were treated with thorough and extensive surgical debridment, external fixation and simultaneous application of allograft and double antibiotic scheme. The patients were followed up initially weekly till stitches removal and every second week till the external fixation removal without developing any signs of infection.

Overall, there were uncomplicated union in 23 cases (18 GII, 3GIIIa and 2GIIIb) whereas in 5 cases we had to change method of treatment (3 GII and 2GIIIa) due to union delay or non acceptable fracture angulations. There were also a case that developed deep infection and septic pseudarthrosis.

The simultaneous external fixation and allograft application seems to provide a small advantage in open fracture consolidation despite the established wisdom for allograft use on a later stage. The proper initial open fracture estimation, the right surgical treatment, the surgeon’s experience and a strict patient’s follow up schedule are fundamental for a good final outcome