treatment of open tibial fractures: convert-ing or continuing external fixation?

background: the treatment of open tibial fractures is still an orthopaedic challenge and full of complications. in many cases the use of external fixator that has been known as a non-:union: machine is obligatory with a high incidence of pin track infection and other complications. the aim of this study was to compare the use of external fixation as a definite method for treatment of open tibial fractures with its subsequent conversion to internal fixation or casting.   methods: sixty-seven young patients with type iii open tibial fractures (gustilo-anderson classification) were treated with half pin external fixation. twenty of them were converted into internal fixation after a period of 6-8 weeks. for another twenty-five, external fixator was removed and treatment continued with casting for a period lasting from 16 to 20 weeks. and for twenty two patients the fixator continued until complete :union:. the patients followed up for 10-16 months and were evaluated in terms of :union: time, :union: rate, infection, range of motion, mal:union:, non-:union:, nerve injury, and reduction.   results: there was a meaningful difference only in the :union: time and superficial infection between the first group and the other two groups.   conclusion: the conversion of external to internal fixation can be considered as a safe, effective, less complicated, and more acceptable method for the treatment of open tibial fractures.