RESUMEN
INTRODUCTION: Accidents currently rank first among causes of complex lower limb injuries. The most common open long bone fractures are tibial fractures. Estimates indicate that there are 492,000 new fractures every year, with a prevalence of 100,000 cases that do not heal. CLINICAL CASE: Young, female patient who underwent emergency surgery for a Gustilo III A open comminuted fracture of the left proximal tibia. Surgical toilette was performed several times until the soft tissues improved. Then internal fixation of large fragments was performed with a cortical screw and Professor Rodrigo Alvarez Cambras' external fixator was used to heal the fracture. The combined approach consisting of internal and external fixation is discussed within the setting of these difficult fractures.