Background:Open fractures of the tibia are mostly caused by high-energy injuries, accompanied by severe soft tissue injuries. Staged operations are reported performing better prognosis in these cases.Case summary:The author reports a case of open comminuted fracture of the left tibia (GustilloIIIA) and discusses its clinical features and treatment experience with the literature. The patient was admitted to our hospital by an ambulance for half an hour due to pain in her left leg caused by a car collision on an electric bike. During hospitalization, external fixation and an intramedullary nail were sequential used.Conclusion:The case report suggests that cortex screws are likely benefit the prognosis of severe open tibial fracture.