Background: bone is one of the very few tissues in the human body that has the innate ability to mend itself after damage. Segmental tibial bone defects pose special therapy challenges that require a personalized strategy because there are numerous factors that can affect the method of treatment, such as age, host status, anatomic position, and the condition of the surrounding soft tissues. Objective: The purpose of his study was to evaluate the Ilizarov external fixator's performance in treating segmental tibial abnormalities in adults through customized surgical methods. Patients & methods; Twenty- four patients with segmental tibial deformities participated in this prospective study, which was carried out at Menoufia University Hospitals. Results: Using the ASAMI rating method, 87.5% of the cases had satisfactory radiological results (34.3% good, 54.2% excellent). According to the clinical results, 83.3% of patients had adequate functional outcomes (58.3% outstanding, 25% good). Significant correlations were found between radiological and functional outcomes (p = 0.016), as well as between the duration of non-union and functional results (p = 0.046). With an overall complication rate of 62.5%, severe edema and pin tract infection were the most common problems (20.8%). 75% of patients were extremely or fairly satisfied with the overall process, which suggests that patient satisfaction was typically very high. Conclusion: According to our research, segmental tibial anomalies of various sources could be effectively treated with the Ilizarov external fixator. With a high patient satisfaction rate and a controlled complication profile, the technique often yields good to extraordinary bone and functional results. Despite persistent challenges, particularly regarding treatment duration and complication management, the Ilizarov procedure remains a valuable tool in the orthopedic surgeon's toolbox for treating complex tibial anomalies.