Actual problems of using intramedullary blocked osteosynthesis for open fractures of the shinbones and femoral bones in patients with combined injuries are considered. The most optimal terms of operative treatment were established depending on the severity of the injuries by ISS scale and on classification of injuries of the soft tissues by Gastillo-Andersen. The schemes of antibacterial prophylactics of infectious complications are proposed both during operation and at the postoperative period. Under consideration are the questions of intraoperative boring of the bone marrow canal of the shinbones and femoral bones in severe combined injuries.