Type III open tibial fracture is difficult to treat beacause of frequent complications, and recently external fixation have been used successfully. Intramedullary nailing with flexible nails is now routinely performed in Type I and II open tibial fractures.

Thirteen cases of Type III open tibial fractures teated with Ender nails from January 1 983 to December 1988 were identified and retrospectively reviewed.

The results were as follows;

1. The patients were predominantly more common in male and the average age was 41 years, and most common cause was traffic accident.

2. According to the Gustilo and Andersons classification, Type III-A was 7 cases, TypeIII-B was 5 cases, and Type III-C was 1 case. All 13 cases were combined fibular fracture.

3. All 13 cases were used two Ender nails, nailing methods were two antegrade insertioni (7 cases), two retrograde insertion (3 cases), and one antegrade & retrograde insertion (3 cases). 8 cases were operated within one day of accident, 7 cases were used other combined metals, and 5 cases were treated with Rush pinning of fibular fracture.

4. Among the secondary additional operation required after Ender nailing, bone operation were 7 cases, soft tissue operation were 5 cases, and delayed amputation were 2 cases.

5. Among II cases except amputation, controversial complications were nonunion (6 cases), chronic osteomyelitis (1 case), delayed union (1 case).

6. A retrospective evaluation of 13 cases treated Ender nailing revealed that Ender nailing was simple, effective method in some selected cases of Type III open tibia fractures.