Innovation in external fixation: Emerging hardware, software and automation technologies

External fixation remains a cornerstone of contemporary orthopaedic trauma and limb reconstruction surgery. While the biological principles for bone healing and regeneration established by Ilizarov continue to underpin modern practice, significant technological innovation has occurred over the past two decades. These developments have focused on improving construct stability, enhancing deformity correction accuracy, reducing technical complexity and improving the patient experience. Advances in hardware design have expanded fixation options and increased the adaptability of circular frames in complex trauma and reconstructive settings. Parallel developments in software have transformed deformity analysis, preoperative planning and correction execution through improved registration systems, virtual frame construction and cloud-based treatment platforms. More recently, remote patient support systems and automated strut technologies have sought to reduce the treatment burden associated with prolonged frame use. This review examines contemporary innovations in external fixation, focusing on developments in hardware, software, patient engagement technologies and automation. The available evidence is critically appraised and future directions explored. While many innovations demonstrate clear theoretical and practical advantages, robust clinical evidence remains limited for several emerging technologies. Nevertheless, the convergence of advanced engineering, digital health technologies and artificial intelligence is likely to fundamentally reshape the future of external fixation.