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Objective: To discuss the effect of coupled external fixator and skin flap transposition on exposed and nonunion bones.Methods: The data of 12 cases of infected nonunion and exposed bone following open fracture treated in our hospital during the period of March 1998 to June 2008 were analysed. There were 10 male patients, 2 female patients,whose age were between 19-52 years and averaged 28 years.There were 10 tibial fractures and 2 femoral fractures. The course of diseases lasted for 12-39 months with the mean period of 19 months. All the cases were treated by the coupled external fixator and skin flap transposition.Results: Primary healing were achieved in 10 cases and delayed healing in 2 cases in whom the tibia was exposed due to soft tissue defect and hence local flap transposition was performed. All the 12 cases had bony union within 6-12 months afer operation with the average time of 8 months. They were followed up for 1-3 years and all fractures healed up with good function and no infection recurrence.Conclusion: The coupled external fixator and skin flap transposition therapy have shown optimal effects on treating infected, exposed and nonunion bones.