The plateau tibial fracture is a challenging pathology where associated lesions can complicate by far the fracture treatment. External fixation could be a valuable option, both in the emergency stabilization and in the definitive synthesis, especially when general or local patient's conditions demand for a tissue sparing approach. This chapter is divided in two, the first part talks about the indications and the technical rules of the bridging external fixators and the clinical applications of Damage Control Orthopedics (DCO) to tibial plateau fractures. The second part is focused on those complex (because of the soft tissue envelope conditions or the fracture pattern) lesions that could take advantage of a definitive treatment based on the external fixation, more frequently circular. Technical and mechanical characteristics, indications, surgical application, pros and cons of the circular frames are described.