Objective To evaluate the external fixators used in early treatment of severe open tibiofibular fractures following the 5.12 earthquake in Sichuan, China. Methods From 12th to 17th of May, 2008, we admitted a total of 116 open tibiofibular fractures of grade Ⅲ in 83 patients who were injured in the Sichuan earthquake catastrophe. They were treated by radical debridement combined with external fixation. Early effects of our treatment were analyzed in terms of incidence of deep infection, amputation and wound healing. Results The short term observation showed that the overall infection rate for all grade Ⅲ open tibiofibular fractures was 17.2% (20 factures). Amputation of limbs was done for 9 fractures of grade Ⅲ C due to ischemic necrosis and 1 fracture of grade III b due to infective necrosis complicated with septicopyemia. The total amputation rate was 8.62%. Twenty injured limbs had deep infections which were controlled by repeated debridement and curettage. Union rate was 100% among all the saved limbs, although some cases required free tissue transfer or rotational muscle flap coverage. Wounds healed by first intention in 52 cases and by second intension in 54 cases. Conclusion In the early treatment of severe open tibiofibular fractures following an earthquake, external fixation may be a useful instrumentation. Key words: Earthquake; Tibia; Fibula; Fracture, open; External fixator