The orthopedic surgeon has a wide array of techniques available to treat upper extremity trauma. Although a majority of injuries can be appropriately treated with internal fixation or immobilization, familiarity with external fixators can be invaluable in certain scenarios. Severe soft tissue injury, gross contamination or infection, and segmental bone loss may be best treated with external fixation in the appropriate clinical context. While modern internal fixation implants have displaced many prior indications for upper extremity external fixation, the external fixator can be a valuable tool in the surgeon’s arsenal when appropriately utilized. Here, we present indications for external fixation in the upper extremity, as well as key points in safe and effective use.