External skeletal fixation in ruminants

External skeletal fixation (ESF) techniques are increasingly being adapted for treatment of fractures in large animals. This article includes detailed information regarding decision making for ESF, biomechanics of ESF, interaction of the bone and implants, general surgical techniques for application of ESF (including traditional ESF, use of acrylic sidebars for ESF, and transfixation, pinning, and casting), discussions of application of ESF to specific bones, and complications associated with the use of ESF. Also, techniques for the management of open, infected fractures are presented. Future directions of ESF research and application also are presented.