Open fractures are at risk of infection due to the wound, and it is important to treat the wound correctly and in a timely manner to prevent infection and strive for rapid healing of the wound, thus converting the open fracture into a closed fracture. The bacteria that invade the wound initially remain only on the surface of the wound, which is then contaminated only. The period of time before the bacteria multiply and invade the tissue is called the incubation period. The length of the incubation period depends on the nature, location, and degree of contamination of the wound, the type, number, and toxicity of the bacteria, the strength of the patient’s local and systemic resistance, and the ambient temperature. If debridement is performed within the incubation period, it can mostly heal in one phase. If the wound is not seriously contaminated within 8 to 12 hours, internal fixation can be added and the wound can be sutured after thorough debridement; for wounds between 12 and 24 hours, debridement can be performed under the protection of antibiotics, and internal fixation should not be implanted. The wound should be closed or not depending on the situation. If severe inflammation is present, debridement should not be performed. In wounds older than 24 hours, infection is difficult to avoid, and debridement can destroy the established infection barrier and spread the infection to the detriment of the patient. In a few cases, when the temperature is low and the contamination is slight, debridement can be considered or even suturing can be considered, although it has been more than 24 hours. There are different opinions on whether to apply internal fixation for open fractures. The traditional method is based on external fixation, because internal fixation can increase tissue damage and aggravate infection. In the past 20 years, the use of internal fixation for open fractures has been increasing, and it is believed that internal fixation not only provides good alignment of the fracture, but also eliminates the abnormal activity of the fracture end, restores the normal anatomical relationship, and eliminates the dead space, which is conducive to the control of infection and causes only a small number of comorbidities. However, which fixation method is best for each fracture should be carefully considered for each injury. If external fixation alone can achieve the treatment requirements, external fixation should still be the preferred method, while in cases where only internal fixation can achieve good results, internal fixation should be used correctly under the premise of strict control of indications. The occurrence of comorbidities such as infection after internal fixation of open fractures is directly related to the degree of tissue damage and contamination. Therefore, the prerequisite for the application of internal fixation is thorough debridement, which should be considered only when the wound is expected to heal basically in one phase. The indications for internal fixation should be as follows: 1. vascular nerve injury, surgical anastomosis, internal fixation can prevent abnormal activity of the fracture end and create conditions for vascular nerve healing; 2. fracture end is extremely unstable, and internal fixation is feasible if simple external fixation cannot meet the treatment requirements; 3. multiple fractures, such as multi-site external fixation, are difficult for patients to tolerate, and surgical internal fixation can be applied selectively to several sites; 4. Multiple fractures of the same limb, such as fractures of the humerus and ulnar radius on the same side or fractures of the femur and tibiofibula on the same side, it is often difficult to achieve the treatment requirements with simple external fixation, and one site should be selected and surgically fixed internally. The treatment is easier with external fixation of the other site. Internal fixation surgery should make use of the original port as much as possible and try to use methods that cause less damage to bone and soft tissue. For example, an oblique or spiral fracture of the tibia can be treated with limited internal fixation with screws in the original orifice, followed by external fixation. For long tubular bone fractures, especially femur, general plate screws cannot meet the fixation requirements, and the stripping range is large and the damage is more serious, so intramedullary nailing should be used as the main fixation. Although the compression plate does fixation, but the soft tissue damage is more serious, generally not applicable to the emergency management of open fractures. After internal fixation of open fracture, if the skin is defective and it is difficult to close the fracture in one phase, healthy muscle can be used to cover the fracture without suturing the skin, and after the inflammation is limited in 5-7 days, the fracture can be closed in two phases or skin flap transplantation can be performed. In cases where the injury is severe and internal fixation or external fixation is not applicable, external fixation brace is now advocated, by inserting fixation pins in the healthy part of the skin of the upper and lower segments of the fracture, with an external fixator, which has the advantage of achieving the purpose of fracture fixation and facilitating wound observation and treatment. It is particularly effective in cases where the tibiofibular fracture wound is seriously contaminated and the debridement is not easy to be completed.