Hao ZC, et al. - A total of 152 patients with open tibial shaft fractures who were treated with external fixation (EF) with or without limited internal fixation (LIF) augmentation were recognized by the researchers in order to compare the outcomes of EF combined with LIF and simple EF in the management of open tibial shaft fractures, estimating the efficiency and safety of using the combined technique in treating such fractures. Out of 152 participants, 85 were randomized in the simple external fixation group and 67 in the EF-LIF group. In order to tolerate full weight and obtain complete bone union while needing additional first surgery time, combined fixation provided shortened time. No meaningful variation could be discovered in infection rates or direct cost of hospitalization. A significant decline in the delayed union and non-union in the EF-LIF group was noted. Patients with combined fixation presented lowered malreduction, loss of reduction, and malunion in limb alignment. The EF-LIF group exhibited a markedly lower incidence in terms of secondary fixation. Hence, for the management of open tibial diaphyseal fractures, combined fixation was concluded as an efficient and safe alternative in comparison to simple EF. Moreover, it gave higher initial reduction, better stability and reduced the risk of inferior alignment and prevented union without elevating the risk of infection.