Open type III tibial shaft fractures have a high incidence of complication and a poor outcome. The most usual method of stabilization is by external fixation, but there are several complications as infection, delayed union and nonunion. We tried to compare the results of Ilizarov external fixation cases with the case of secondary intramedullary nailing after temporary Ilizarov fixation. There was no significant difference in the union time of Ilizarov external fixation and secondary intramedullary nailing after temporary Ilizarov fixation. But the patients were more comfortable in the secondary intramedullary nailing. In conclusions, secondary intramedullary nailing after temporary Ilizarov fixation is the useful method in the treatment of open type III tibial shaft fractures.