Background: External skeletal fixator is an important aspect of fracture management. Patients with external fixation device have limited activity of daily livings and often have negative effects on their self-care abilities. The aim of the study: Was to evaluate the effectiveness of nursing guidelines regarding self-care strategies for patients with external skeletal fixation. Research design: Quasi experimental research design was used to conduct the aim of this study. Setting: The study was conducted in the orthopedic department and outpatient clinics for orthopedics affiliated to Benha University Hospital, Benha, Egypt. Sample: Convenience sample of all available patients were taken from both sexes , their age ranged from 20 to 60 years old during six months (n= 55). Tools: Three tools were used; (1) Patients' interviewing questionnaire (2) Barthel Index (3) Pain assessment scale. Results: There were high statistically significance regarding the overall knowledge about the skeletal system , fracture , orthopedic fixator and self-care at pre and post implementation of guidelines, there were highly statistical differences of patients' reported practice regarding external skeletal fixation, there was positive improvement regarding patients' independency in activities of daily living and also, self-care improved significantly after applying of guidelines. Finally there were statistically significant differences regarding all items of pain assessment between pre, immediate, and one moth post guidelines implementation. Conclusion: The mean patients' knowledge and practice scores after implementation of nursing guidelines were higher than as compared to before regarding self-care strategies for patients with external skeletal fixation. Recommendations: Ongoing educational and training programs are needed for patients with external fixation regarding self-care strategies to reduce and prevent complications and apply the program on large sample selected from orthopedic department at Benha University Hospital.