The treatment of open comminuted tibial shaft fractures have a high incidence of complications and often result in poor outcomes. General principles of treatment are accepted throughout most surgeons, which include aggressive debricdement, antibiotics, early stabilization, early soft tissue coverage, and prophylactic bone graft. But, recently there is a controversy on the bony stabilization methods; one group of authors favors external fixator, and the other group favors unreamed interlocking intramedullary nail. In this paper, we carried out retrospective study of the 42 cases of open comminuted tibial shaft fractrues managed with Ilizarov external fixator (minimum follow up of one year(average: 2.8 years)). The purpose of this study is to evaluate the results of treatment with an Ilizarov method for the patients with open comminuted tibia fractures (open type III-A and more by Gustilo and Anderson classification and, type B and more by AO classification). The results were as follows; 1. It has taken 7.4 months to achieve bony union with relatively delayed healing time for the diaphyseal fractures and fractures with higher energy injury on AO classification). The results were as follows; 1. It has taken 7.4 months to achieve bony union with relatively delayed healing time for the diaphyseal fractures and fractures with higher energy injury on AO classification. 2. Forty eight additional operations were needed for 27 patients; 24 bone grafts for 19 atients, 1 case of bone marrow injection, 4 cases of corticotomy and bone transport, 4 cases of sequestrectomy, 3 cases of internal fixation with plate, 2 cases of IM nailings, and 2 cases of Ilizarov correction in operating room. 3. Following complications were resulted in; delayed union 14 cases, nonunion 1 case, superficial infection 2 cases, deep infection 8 cases, chronic osteomyelitis 3 cases, refracture 2 cases, knee stiffness 6 cases, ankle stiffness 5 cases, subtalar stiffness 8 cases, lateral angulation 4 cases, anteroposterior angulation 4 cases, and leg length discrepancy 5 cases. 4. Twenty patients, at the final follow-up, could walk without limping and live their life with no activity limitation. 5. At the final follow-up, 19 patients complained intermittent pain on fracture sites, knees or feet and ankles. We could conclude that the Ilizarov external fixator can be a stabilizer of choice for the open comminuted (Gustilo type III and more than AO type B) tibial shaft fractures of which fracture line extended over the proximal or distal metaphysis.