Type III open fractures of the humerus caused by high energy missiles or shrapnel in 26 male soldiers were treated by external fixation. 12 suffered from associated injuries involving the head and chest, 12 had 14 nerve injuries, and 4 required simultaneous repair of the brachial artery. Results in 19 examined after an average of 6.5 years were excellent in 22%, good in 52%, fair in 16%, and poor in 10%. The aim of external fixation is functional limb salvage. We think high-energy gunshot fractures should be classified as III-d because of the severe damage to the soft tissue, which differs from that of low-velocity, gunshot fractures or farm injuries. We conclude that external fixation is the preferred form of primary stabilization of severe open fractures of the humerus. It has reduced the incidence of chronic infection and has improved the prognosis of vascular repairs. The treatment of the soft tissues, skin coverage, and ultimately reconstructive surgery are facilitated. Early limb function allows for a better final result. For delayed union and pin-tract infection a different definitive method, such as internal fixation or a plaster case, is required.