The deleterious association of non-bone consolidation and septic complication is a therapeutic challenge for orthopedic surgeons. Tibial fractures are a source of high rates of nonunion and septic and cutaneous complications. Here we present the case of a 56-year-old patient with a history of vascular, cardiac and obstructive post-smoking bronchopneumopathy who presented septic pseudarthrosis of the left tibial pilon with cutaneous complications and whose treatment consisted of , initially in an induced membrane technique, associated with a cutaneous cover by a lateral fasciocutaneous flap of the thigh and an osteosynthesis by a Hexapodal external fixator type True Lock. During the second stage, the bone graft was removed by endomedullary boring of the contralateral femur using the device named Reamer-Irrigator-Aspirator, and the stems of the external fixator were replaced by other rods allowing adjustment multiplicane and thus a gradual three-dimensional reduction as the consolidation progresses.