Twenty-seven patients with complex fractures of the lower end of the tibia were treated by an external Hoffman fixator between 1977 and 1981. Its use was inspired by the presence of skin lesions and by the anatomical type of fracture when it was felt that other methods of treatment would be ineffective or hazardous. In favour of the method was the absence of iatrogenic infection and anatomical results that were superior to those of conservative treatment. Against it, there was a longer time for union, with eight delayed unions and three non-unions and the fact that it was impossible to correct joint impaction which was present in 14 out of 28 cases.