The treatment of the open tibial fractures is still an orthopaedic challenge and full of complications. In many cases the use of external fixation that has been known as a non-union machine is obligatory with a high incidence of pin track infection and other complications. The aim of this study was to compare the use of external fixation as a definite method of treatment of open tibial fractures with it’s subsequent conversion to internal fixation or casting.

During June 2004 to July 2006 in a randomized controlled trial 67 patients with types A and B of Arbeitsge-meinschaft fur Osteosynthesefragen (AO) open type III Gustilo tibial and fibular diaphyseal fractures were studied. Mean age of the patients was 25 years (18–40 years) and mean follow up time was 8 months.

After the external fixation of the fractures, the patients were divided into three groups by drawing from the random table of numbers. Group one consisted of 20 patients were selected for delayed conversion to internal fixation after 6–8 weeks (after three weeks of removal of external fixator).

Group two consisted of 25 patients in whom external fixation had continued in order to convert to Patellar Tendon Bearing (PTB) cast after developing union.

The remaining 22 patients were considered as group three in whom external fixation was continued until complete union.

There was a meaningful difference only in the union time (P=0.001) and superficial infection (P=0.018) between the first group and the other two groups.

So, in the treatment of the open tibial fractures there is priority for method of conversion of the external fixation to internal fixation compared to the other protocols of treatment.