The feasibility and effectiveness of treating tibial fractures with a hexapod external fixator combined with a unilateral locking external fixator based on CT data
Authors: Xu Zhaochen , Chen Yongcheng , Lu Yufeng , Cao Xiaoming , Zhang Meng , Qiao Feng 
Published: August 2024

Abstract

Background
A Q spatial fixator (QSF) is a self-developed hexapod external fixator that is based on CT data. It is composed of a ring fixator and a unilateral locking external fixator. It is mostly ideal for fractures with severe soft tissue injury, can accurately perform fracture reduction, and has good clinical efficacy. This study aims to assess the feasibility and effectiveness of QSF in treating tibial fractures.
Methods
A retrospective investigation was performed on a cohort of 44 patients who were admitted to Xi'an Honghui Hospital between April 2022 and May 2023, all of whom had tibial fractures. The study included 26 males and 18 females, with an average age of 39.59 years (ranging from 15 to 64 years). The average BMI was 22.31 kg/m², with a range of 15.57 to 32.28 kg/m². Out of the total, 26 individuals had fractures on the left side, 18 had fractures on the right side, 37 had fractures in both the tibia and fibula, and 7 had fractures just in the tibia. The patients' clinical and imaging data were gathered and examined retrospectively. Every patient was monitored for a minimum of 3 months after the removal of the QSF. During the most recent assessment, the clinical results were assessed using the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI).
Results
The mean surgical time for patients was 53 minutes, ranging from 30 to 75 minutes. The mean blood loss amounted to 49 mLs (range: 10–150 mLs). The mean hospital stay was 5 days, ranging between 1 and 9 days. No intraoperative complications were noted, and four patients (9.09%) developed a superficial pin tract infection postoperatively. These infections were successfully treated through regular dressing changes. All patients accomplished bone healing, with an average healing duration of 121 days (ranging from 90 to 150 days). The patients were monitored for a mean duration of 112 days (ranging from 85 to 150 days) after the withdrawal of QSF. All patients experienced significant decreases. Statistically significant differences were observed in the translation and angulation on the preoperative anteroposterior radiograph, the translation, and angulation on the preoperative lateral radiograph, and the difference in preoperative lower limb length and postoperative correction achieved (P < 0.05). According to the ASAMI grading criterion, the bone grade was outstanding in 40 cases, which accounted for 90.01% of the total, and good in 4 cases, which accounted for 9.09%. The functional grade was deemed exceptional in 42 cases, accounting for 95.45% of the total, while it was considered good in 2 cases, making up 4.55% of the total.
Conclusion
QSF is an alternative and effective method for the treatment of tibial fractures. It has the technical advantages of early trauma control and a commendable reduction effect. It is appropriate for cases involving highly intricate and severe deformities, particularly for situations with considerable damage to the soft tissues that cannot be addressed or are not suitable for internal fixation.