BackgroundOpen fractures associated with significant tissue loss are complex and present challenges in management; they are associated with poor outcomes such as infection, non-union or amputation. This study aimed to evaluate outcomes of using an adjuvant local antibiotic hydroxyapatite bio-composite in the management of open Gustilo-Anderson IIIB fractures with up to eight years of follow-up.MethodsThis was a retrospective study. A total of 81 patients with Gustilo-Anderson IIIB fractures treated with “fix and flap” limb reconstruction with adjuvant local antibiotic therapy using a bio-composite carrier were reviewed.ResultsThe mean follow-up time for all the patients, at the time of data collection, was 55.8 months. Union was achieved in 96% with a limb salvage rate of 96.3% and a deep infection rate of 3.7%.ConclusionThe use of local antibiotic therapy, together with a combined orthoplastic “fix and flap” approach for Gustilo-Anderson IIIB open fractures, was found to be associated with a very low rate of metalwork infection and high union and limb salvage rates. Future studies should include some functional and quality of life outcome measures to see the efficacy of this method.