SummaryThe general principles of external fixation of the tibia from the viewpoint of its role in private practice are discussed. The volume and pattern of injuries, as well as the patient mix, changes from the trauma center setting to private practice and the role of external fixation changes as well. Key indications for external fixation in this setting include temporary and definitive stabilization of periarticular fractures with soft-tissue compromise and severe open shaft fractures of the tibia. The emphasis, in these complex cases, is on temporary external fixation for initial soft-tissue management with staged early conversion to internal fixation. Technique and patient management principles, complications, and their prevention are discussed.