Introduction: Open tibial plateau fractures are associated with significant soft tissue injuries which increase the risks of complications and their management is highly challenging. Ilizarov external circular fixation is an ideal method of treatment when extensive soft tissue dissection and internal fixation are contraindicated. This retrospective study aimed to evaluate the midterm results of managing open complex tibial plateau fractures with Ilizarov fixator. Patients and Methods: The study included 27 patients with open tibial plateau fractures (Schatzker Types V and VI) with a mean age of 40.56 years. They included 17 males and ten females. Sixteen fractures were open type III-A and 11 were type III-B according to the Gustilo classification. Seven cases had associated injuries. Five patients had previous temporary spanning external fixation. Three patients were diabetics. Above knee frame extension was done in 14 cases. Assisted wound closure by the frame was done in three cases. Results: All fractures were fully united with mean fixator period of 18.37 weeks. The average follow up duration was 8.52 years. No patient developed a deep infection. According to ASAMI score, the results were evaluated as excellent in nine patients, good in 14 patients, fair in four patients. The overall result was judged as satisfactory by all patients. Conclusion: The treatment of complex tibial plateau fractures with the Ilizarov fixator is safe, versatile, and effective treatment option, and produces good functional results. It, also, allows early full weight-bearing and good rehabilitation