Modern external skeletal fixation (ESF) is a very versatile system that is well suited to the ideals of minimally invasive osteosynthesis (MIO). It offers variable-angle, locked fixation that can be applied with minimal to no disruption of the fracture zone. Technological advances in ESF have fostered the ability to use more simple frame applications than in previous generations. Even when rigid bilateral or multiplanar frames are required, timely staged-disassembly is easy to perform and allows for a gradual shift of loading from the frame to the healing bony column. Hybrid ESF is ideally suited for the MIO treatment of many juxta-articular fractures and osteotomies. Adherence to the principles of ESF and postoperative care is essential to overcome the various disadvantages that are inherent to ESF.