A and B, Clinical photograph and initial radiograph of pedestrian struck by vehicle at high speed. Presented with Gustilo 3B open proximal fibular and tibial fractures. Note large bone defect. C and D, Fracture managed with multiplanar ring external fixator secondary to overlying soft-tissue injury requiring skin grafting. Osseous defect managed with bulk autogenous bone grafting and acute compression/shortening of fracture in wire frame after removal of large antibiotic spacer.