Management of the severe (Type III) open tibial fractures has long been one of the most difficult problems facing the orthopaedic surgeons. Healing times are longer and complication rates higher than typically encountered for other common fractures, The authors reviewed 48 cases of type III open tibial fractures in adults, treated at the Department of Orthopaedic Surgery, Dong-Kang Hospital from January 1984 to December 1989, and obtained the following results;l. In case of difficult reconstruction with local flap, open cancellous bone graft was effective. 2. Early soft tissue reconstruction was helpful for early bone graft 3. Bone coverage within 1 week and bone graft within 6 weeks enabled the fracture to unite early. 4. Average bone union time was 9 months.