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TL-HEX TrueLok Hexapod System™

Stable. Simple. Versatile.

TL-HEX is a hexapod external circular fixation system developed at Texas Scottish Rite Hospital for Children (TSRHC) in Dallas, Texas, US.

It consists of hardware and associated software for simplified deformity correction and trauma management. TL-HEX will support fracture fixation, limb lengthening, treatment of non-union and deformity corrections in long bones in both adult and pediatric patients.

TL-HEX TrueLok Hexapod System™



In essence, the system consists of circular and semi-circular external supports secured to the bones by wires and half pins and interconnected by six struts. This allows multi-planar adjustment of the external supports.

The rings position is adjusted either rapidly or gradually in precise increments to perform bone segment repositioning in three-dimensional space. All components of the TL-HEX are compatible with the TrueLok Ring Fixation System; therefore, external supports from both systems can be connected to each other when building fixation blocks.


The web-based TL-HEX software supports surgeons throughout pre/intra/post-operative phases.

The HEX-ray Integrated Module is designed to facilitate pre-operative planning and post-operative correction by uploading of digital x-ray images into the software.

  • Measurements calculation
  • Frame templates in preplanning
  • Automatic data input into TL-HEX software

Time and Cost-saving Solution.

Mechanical tests sponsored by Orthofix and performed at Texas Scottish Rite Hospital for Children, highlight that TL-HEX with ball-and-socket universal joint struts provide more stability than hexapod frames with cardan universal joint struts. TL-HEX with its high frame stability, represents a time- and cost-saving solution for circular fixation.


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Efficacy, Accuracy, Stability, Versatility
ease-of-use and cost-effectiveness.
6 evidence-based advantages of TL-HEX.


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Safe and Effective.

Independent Clinical Studies support the safety and efficacy of the TL-HEX System in trauma, deformity correction procedures and in the treatment of non-unions.


The tibial bayonet method of wound closure.

Strategies in Trauma and Limb Reconstruction, 2018
O'Farrell P, Barnard AC, Birkholtz F.
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Monofocal distraction treatment of stiff aseptic tibial nonunions with hexapod circular external fixation.

Journal of Limb Lengthening & Reconstruction, 2017
Mahomed N, O'Farrell P, Barnard AC, Birkholtz FF.
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Hexapod external fixator closed distraction in the management of stiff hypertrophic tibial nonunions.

The Bone & Joint Journal, 2015
Ferreira N, Marais LC, Aldous C.
Click here to open the abstract

Management of tibial non-unions according to a novel treatment algorithm.

Injury, 2015
Ferreira N, Marais LC.
Click here to open the abstract

Femoral locking plate failure salvaged with hexapod circular external fixation: a report of two cases.

Strategies in Trauma and Limb Reconstruction, 2016
Ferreira N, Marais LC.
Click here to open the article

Deformity Correction

Orthoplastic consideration during distal tibia deformity and limb lengthening utilizing Truelok hexapod circular external fixator.

Journal of Orthopaedics Trauma Surgery and Related Research, 2018
Rodriguez-Collazo E, Frania S, Hyrczyk J.
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Deformity Correction

Evaluation of the external fixator TrueLok Hexapod System for tibial deformity correction in children.

Orthopaedics & Traumatology: Surgery & Research, 2017
Pesenti S,Iobst CA, Launay F
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The use of gradual correction with the TL-HEX external fixator in Blount’s disease.

Bone Joint Journal, 2014
Mare P, Thompson D.
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Congenital dislocation of the knee in a three-year-old-child with Larsen syndrome: Treatment with a hexapod-type external fixator.

Knee, 2018
Klein C, Bulaid Y, Deroussen F, Plancq MC, Printemps C, Gouron R.
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Treatment of complex foot deformities with hexapod external fixator in growing children and young adult patients.

Foot and Ankle Surgery, 2018
Riganti S, Coppa V, Nasto LA, Di Stadio M, Calevo MG, Gigante AP, Boero S.
Click here to open the abstract

Correction of complex lower limb angular deformities with or without length discrepancy in children using the TL-HEX hexapod system: comparison of clinical and radiographical results.

J Pediatr Orthop B, 2019
Riganti S, Nasto LA, Mannino S, Marrè Brunenghi G, Boero S.
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A comparison of deformity correction capabilities in hexapod frame systems.

Journal of Limb Lengthening & Reconstruction 2016
Iobst CA, Samchukov M, Cherkashin A.
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Radiographic analysis of hexapod external fixators: fundamental differences between the Taylor Spatial Frame and TrueLok-Hex.

Journal of Medical Engineering and Technology, 2015
Ferreira N, Birkholtz F.
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The effect of HIV infection on the incidence and severity of circular external fixator pin track sepsis: a retrospective comparative study of 229 patients.

Strategies in Trauma and Limb Reconstruction, 2014
Ferreira N, Marais LC.
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Treatment Strategies and Frame Configurations in the Management of Foot and Ankle Deformities.

Clinics in Podiatric Medicine and Surgery, 2018
Cherkashin AM, Samchukov ML, Birkholts F.
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Preliminary results using patient-specific 3d printed models to improve preoperative planning for correction of post-traumatic tibial deformities with circular frames.

Injury, 2018
Corona PS, Vicente M, Tetsworth K, Glatt V.
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TL-HEX Trauma

All that you need… in one tray.

In periarticular fractures the application of minimally invasive wires and circular fixation is one effective option with proven outcomes*. Three steps from Trauma Frame to Definitive Hexapod: TL-HEX Trauma combines the advantages of a quick, precise application with the help of software as and when it is needed.


“Bycondylar tibial plateau fractures treated with fine wire circular fixation”, Ferreira N, Marais L.C.- Strat Traum Limb Recon (2014) 9:25–32.

“High tibial plateau fractures treated with hybrid external fixation”, Babis GC, Evangelopoulos DS, Kontovazenitis P, Nikolopoulos K, Soucacos PN - Journal of Orthopaedic Surgery and Research 2011.

“Distal tibial fractures treated with hybrid external fixation”, Babis GC, Kontovazenitis P, Evangelopoulos DS, Tsailas P, Nikolopoulos K, Soucacos PN - Injury, 2010 Mar;41(3):253-8.

“Management of distal tibial intra-articular fractures with circular external fixation”, Lovisetti G, Agus MA, Pace F, Capitani D, Sala F - Strat Traum Limb Recon (2009) 4:1–6.

“Combined Percutaneus internal and external fixation of complex tibial plafond fractures”, Faldini C, Manca M, Digennaro V, Leonetti D, Nanni M, Romagnoli M, Biagini C - G.I.O.T. 2006; 32:33-39.

“Treatment of high energy tibial plateau fractures”, Narayan B, Harris C, Nayagam S - Strat Traum Limb Recon 2006; 1:18-28.

“The use of trans-articular and extra-articular external fixator for management of distal tibial intra-articular fractures”, El-Shazly M, Dalby-Ball J, Burton M, Saleh M - Injury, Int. J. Care Injured 32 (2001) S-D-99-S-D-106.

TL-HEX Trauma

Some components may not be available. Please contact your sales representatives for availability.

All TL-HEX components are fully compatible with the
TrueLok Ring Fixation System.

Care HEXcellence


From the very beginning
to the end of the treatment,
beside your patient.

In the context of a deformity correction with a device such TL-HEX, the outcome of the treatment may also be influenced by the patient commitment and adherence to the post-operative protocol. Therefore, as we are focused on supporting you to gain a better patient outcome, a brand new set of patient support materials has been developed, for both pre- and post-surgery phases.

Some materials and services may not be available in your Country. Please contact your sales representatives for availability.


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Informative Brochure

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Kit for kids

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Comic Strip

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Implant Removal

End of Treatment

Patient testimonials

CareHEXcellence for patients’
post-surgical rehabilitation

The immediate post-surgical period after discharge from the hospital is generally a critical time in orthopaedical patients. The incorporation of patient-facing mobile applications providing technical and psychological support in post-surgical rehabilitation is of great interest for patients, surgeons and the whole healthcare system.

Care HEXcellence provides a lot of materials and tools for post-surgical rehabilitation, like mobile applications, to support your patients towards a complete recovery.


If you want to know more about our commitment to paediatric patients please visit our page.


Need technical support?


TL-HEX customer care is open 9am-5pm (CET)
Monday to Friday (except bank and public holidays).
Contact us for any support needed (forgotten password, further information requests, ...) on TL-HEX hardware and software.


Click on one of the questions to expand text

How do I obtain the credentials to access the TL-HEX software?

  1. Go to TL-HEX website Home page.
  2. Click on "Request an Account" on the site header and select your country. You will be promptly redirected to the Registration Form.
  3. Fill in the form with the required data and submit your request to obtain a valid TL-HEX account.
  4. Your request will be validated and you will be notified about the progress of your submission by email.
  5. If your request is approved you will receive an email with your credentials.
  6. It is warmly recommended to change the password that you receive at registration stage.

What if I don’t receive any email?

Please verify if your anti-spam filter has blocked the email coming from If there isn't any blocked email, please contact the TL-HEX Customer Care to check the status of your request.

How do I sign in?

  1. Go to TL-HEX web site Home page.
  2. Click the "Login" button. You will be promptly redirected to the TL-HEX Application page available for your country.
  3. Access the application providing username and password in the appropriate fields.
  4. Press the "Sign in" button.

What happens if I forgot or lost my username ID or password?

Click the “Forgot your Username or Password?” link in the TL-HEX Application home page. Enter your username and an email with a new password will be promptly forwarded to your email address. If you have forgotten your username, please contact

What are the system requirements to access the online software?

The software is a web application that requires:

  • Display settings: Screens Resolution of 1024 x 768 pixel or higher
  • Supported Browser: Microsoft Internet Explorer® Version 8 or 9
  • High-speed Internet connectivity is recommended

Other system configuration cannot guarantee the correct running of the application.

How do I contact the Technical support or Customer Care?

You can refer to the "Contact Us" section and choose the way you prefer to be in contact with TL-HEX Customer Care and our technical support.

How do I find the Product Documentation and knowledge base?

Once you have been registered successfully to the TL-HEX application you will have access to the "Instruction for Use" section. In this section, you can find the downloadable pdf version of the TL-HEX General Principle and Software User Guide, as well as other useful resources.

Are TrueLok and TL-HEX compatible?

TrueLok Hardware is fully compatible with the TL-HEX hardware. TrueLok Instrumentation is the same for the TL-HEX. Furthermore, TrueLok rings can be used to complete a TL-HEX frame if needed.