Introduction: The management of Gustilo-Anderson type-Ⅲ open tibial fracture is complex due to neurovascular damage and soft tissue loss. Combined orthopedics, plastic, and vascular surgery provides better results for reconstructing the injuries of the limb. The prevalence of tibial shaft fractures is estimated to be about 67%.1,2 Tibial shaft fractures are approximately 15% of all adult fractures, and open tibial fractures are about 23.5%.1 Rigid fixation and good soft tissue coverage are essential for management of the fracture. Ilizarov external fixator provides multi-disciplinary management of type Ⅲ open tibial fractures with severe contamination and comminution.

Purpose of the study: To evaluate the clinical efficacy of the Ilizarov external fixator with or without fasciocutaneous flap transplantation in the management of Gustilo-Anderson type-Ⅲ open tibial fracture.

Methodology: In the period of 2020 -2021, we managed 5 cases of Gustilo- type-Ⅲ open tibial fracture by Ilizarov. 2 patients were type-ⅢA and 3 type-ⅢB with severe contamination and comminution. No neurovascular damage. All are male, aged 30- 65 years, and caused by RTA. There was 1 diabetic and 1 hypertensive patient. Surgical toileting, debridement, and posterior slab apply as immediate management. All patients were managed by Ilizarov on the 5th and 7th day with secondary closure of type-ⅢA and vascularized fasciocutaneous flap with skin grafting in type-ⅢB cases by orthopedic and flap surgeons.

Summary: Full weight bearing was allowed on 3rd POD. Soft tissue was healed within 3-6 weeks. In 1 case, skin infection was found, treated with antibiotics and dressing; in 1 case, flap edge necrosis occurred, managed by debridement and 2nd time skin graft. Bone union time was 5-6 months, RUST scores 10. According to the ASAMI score, all were excellent results.

Conclusion: RTA is the main cause of type Ⅲ open tibial fractures. Combined multidisciplinary management by Ilizarov provides excellent outcomes, early mobilization, and infection control. It is a single-stage definitive management, which reduces treatment cost, patient mortality, and morbidity.

Chowdhury Foyzur is a highly skilled Orthopedic Specialist in Sylhet, specializing in Bone, Joint, and sports injuries, as well as Ilizarov Surgery. With MBBS and MS qualifications, he serves as a Senior Consultant at North East Medical College & Hospital, providing expert care for complex orthopedic conditions.