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Contemporary recommendations for primary and revision ankle arthrodesis favor internal compression techniques using screw and/or plate fixation, with satisfactory outcomes being reported for most patients. Recently, comparable union rates and results of primary and revision tibiotalar arthrodeses have been reported using ring external fixation. In select patients, tibiotalar arthrodesis with internal fixation may be limited or even contraindicated given insufficient bone stock to adequately support implants, an abundance of avascular bone, or a history of osteomyelitis. Ring external fixation may facilitate clinically acceptable limb salvage in these complex cases. This review paper describes the authors' experience using ring external fixation for ankle arthrodesis.