Background: The external fixation device had been the gold standard for treatment of many types of fractures that cannot be treated by traction or cast. Orthopedic nurses increasingly play integral roles in all aspects of orthopedic care. The study aimed to assess nurses' performance regarding orthopedic patients with external fixation at Zagazig University Hospital. Research design: A descriptive design was used. Tools of data collection: A self-administered questionnaire and observational checklist were used to collect data. Study subjects: convenient sample of 55 nurses working at orthopedic departments at Zagazig university hospitals. Results; Studied nurses’ age ranged between 28 - 58 years and all of studied nurses were females. 90.9% of studied nurses had a diploma degree in nursing science and hadn’t attended previous training about caring of the orthopedic patient with external fixation. 71% of studied nurses had unsatisfactory total knowledge and 51% of studied nurses had inadequate total practice regarding care of patient with external fixation. 80% of the studied nurses’ performance was affected by environmental factor, while (14.5 %, 18.2%, and 29.1% respectively) of the studied nurses were affected by occupational, administrative, and psychological factors. A statistically significant relation was found between factors affecting nurses’ performance and their demographic characteristics at nursing qualification. Also there was a statistical relation between nurses’ total knowledge regarding external fixation and nurses total practice at care of patients’ positioning. Conclusion: Nurses had unsatisfactory level of knowledge and inadequate practice regarding care of orthopedic patient with external fixation and most of the studied nurses reported that their performance was affected by environmental occupational, administrative, and psychological factors. Recommendation: Educational programs should be held periodically for such group of nurses to provide clear idea about the proper care of patient with external fixation, external fixation complications, pin site care, dressing and the factors affecting these performances.