Introduction: Open fractures of the limbs are a formidable surgical emergency because of the osteo-muscular damage and the high risk of infection. External fixation is a method of choice, allowing the fracture site to be stabilised at a distance. This work analyses the anatomical, functional and medico-legal results of management with external fixators in the Department of Orthopaedics and Traumatology of the Ignace Deen National Hospital in Conakry. Patients and Methods: This was a 12-month prospective study (1 January – 31 December 2019) that included 27 cases of open fractures of the limbs treated by external fixator among 34 cases collected (out of 297 hospitalisations). Epidemiological, clinical, therapeutic and outcome data were collected. Skin opening was classified according to Cauchoix and Duparc, and results were assessed using the Johner and Wruhs criteria. Results: The mean age was 36.5 years (range: 13–60 years), with a male predominance (sex ratio = 2.8). Road traffic accidents (RTAs) accounted for 66.67% of aetiologies. The leg was the most frequent site (81.48%). The Hoffmann fixator was used in 77.78% of cases. Ten cases of infection were recorded, including 5 sequestrating osteitis. The mean length of hospital stay was 106 days. At final evaluation (12 patients in dynamic follow-up), results were excellent in 58.34%, good in 25%, fair in 8.33% and poor in 8.33%. Conclusion: External fixation remains an effective method for the management of open fractures of the limbs in African conditions, giving good anatomical and functional results despite prolonged delays before care. The medico-legal impact, particularly in the context of RTAs, calls for rigorous documentation and systematic expertise.