Abstract: Introduction. In practice, an open comminuted fracture treatment severity of long bones, with an extensive defect in the diaphysis bone tissue, the bone metadiaphyseal part, is due to an increased risk combination of developing infectious complications due to an open infected wound, with the need to restore a significant volume of bone tissue, to connect the proximal and distal fragments of long bones. Internal osteosynthesis of bone fragments is impossible due to the lack of the required diaphysis bone tissue volume, the bone meta-diaphyseal part, necessary to restore the normal bones length,and performing open reduction, immediately after trauma, negatively affects blood supply, leads to the complications development such as soft tissue necrosis, infection, and suppuration.The article describes the staged fracture treatment method with the defect replacement with autobone, while maintaining the limb length, reducing the developing pathological risk processes. Purpose of the study – to study the open double comminuted fractures treatment effectiveness of the patient's long bones, with an extensive defect in the diaphysis bone tissue or bone meta-diaphyseal part, by staging the transosseous fixation use with Ilizarov or the rod-rod apparatus, bone grafting with a fibula graft according to the classical technique and intramedullary osteosynthesis. Results and discussion. A temporary transosseous extrafocal limb fixation was performed with Ilizarov or the wire-rod apparatus until the acute period subsided, edema decreased, and blood circulation improved.The fibula was harvested with a length suitable to the defect site.Intramedular metal osteosynthesis or internal osteosynthesis with smooth wires and an apparatus for external fixation of long bones with the bone defect replacement with an autologous bone from the fibula was performed.After bone fusion, external fixators, metal intramedullary implants and internal wires were removed.Achieved preservation of the anatomical segment length, satisfactory restoration of limb function, all fixing structures were removed, and the limb does not contain foreign bodies. Conclusion. The various techniques and technical facilities combination, external fixation, autotransplantation using the classical technique and intramedullary fixation, made it possible to completely restore the injured limb, reduce the complications risk, and obtain good clinical results.