Key Takeaways & Executive Findings
- •• The digital six-axis external fixator (Qiao's frame) provides more precise anatomical reduction, while the unilateral external fixator reduces the bulk and complexity of traditional ring external fixators, lowering nursing burden. • Using CT-based digital six-axis external fixator enables closed reduction with a reduced incidence of pin tract complications, demonstrating the safety of the Qiao's frame-assisted unilateral external fixator technique. • The technique further validates comprehensive clinical benefits including operative time, medical cost, and patient experience, and is recommended for complex fractures such as tibial shaft fractures combined with femoral shaft fractures. • The Qiao's frame-assisted unilateral external fixator technique offers a minimally invasive and effective innovative treatment option for closed and open tibial shaft fractures; future research should further validate its comprehensive advantages and expand its applicability.
Abstract
BACKGROUND: The trend in external fixator development is towards intelligence and miniaturization. Professor Qiao Feng of Xi'an Honghui Hospital designed a digital six-axis external fixator technology, based on CT data, which can accurately reduce fractures and is applied to lower limb fracture and orthopedic treatment, known as the Qiao's spatial frame technology. Considering the large size of the digital six-axis external fixator, Professor Qiao Feng further developed a digital six-axis external fixator-assisted reduction and unilateral external fixator technology for the treatment of tibial shaft fractures. The developed unilateral external fixator is small in size, can be coupled with the six-axis external fixator, and is relatively less expensive than similar external fixators such as the Taylor spatial frame. OBJECTIVE: To explore the effectiveness and reliability of digital six-axis external frame (Qiao's spatial frame) assisted reduction and unilateral external fixator fixation for the treatment of tibial shaft fractures. METHODS: A retrospective analysis was conducted on 103 patients with tibial shaft fractures treated with digital external fixators in the Department of Integrated Traditional Chinese and Western Medicine Orthopedics of Xi'an Honghui Hospital from January 2018 to December 2022. According to the fixation protocol, patients were divided into two groups: Qiao's frame group (51 cases) and Qiao's frame + unilateral external fixator group (52 cases). Four weeks after reduction, fracture displacement distance and angulation were measured on X-ray films. Independent sample t-test and chi-square test were used to compare fracture displacement, fracture healing time, lower limb function scores, and pin tract complication rates. RESULTS AND CONCLUSION: (1) There was no significant difference in fracture displacement at 4 weeks after reduction between the Qiao's frame group and the Qiao's frame + unilateral external fixator group (P > 0.05). (2) There were no significant differences in fracture healing time, lower limb function scores, and pin tract infection rates between the two groups (P > 0.05). (3) Compared with the Qiao's frame group, the number of cases with pin tract traction pain in the Qiao's frame + unilateral external fixator group was significantly reduced (15 cases vs. 2 cases), with a significant difference (P < 0.05). (4) The Qiao's frame assisted unilateral external fixator fixation technique, by coupling the digital six-axis external frame with a unilateral structure, achieves anatomical reduction and stable fixation while significantly reducing the volume of traditional ring external fixators, and has a lower incidence of pin tract complications, providing a minimally invasive and effective treatment option for closed and open tibial shaft fractures.
1. Introduction
Tibial shaft fractures are among the most common fractures. Due to the sparse soft tissue coverage on the medial side of the tibia, the proportion of open fractures is relatively high. Even if the fracture is not open, there may be severe soft tissue injury [1-2], making infection more likely. For open fractures, current surgical methods include: (1) temporary external fixation followed by conversion to plate or intramedullary nail fixation after soft tissue improvement; (2) external fixation as definitive treatment. For closed fractures: (1) plate and screw fixation; (2) intramedullary nail fixation; (3) external fixation. Although intramedullary nailing is the gold standard for closed tibial shaft fractures, it still has many problems, such as difficulty in intraoperative reduction [3], anterior knee pain [4], and difficulty in implant removal [5].
Despite the large size and inconvenience of external fixators, they still offer many advantages for treating tibial shaft fractures, including minimally invasive, simple operation, and easy removal after fracture healing. Especially with the advent of digital six-axis external fixators, not only can anatomical reduction be achieved, but also strong fixation, providing good therapeutic effects for both open and closed tibial shaft fractures [6-9]. The trend in external fixator development is towards intelligence and miniaturization. Professor Qiao Feng of Xi'an Honghui Hospital designed a digital six-axis external fixator technology based on CT data, which can accurately reduce fractures and is applied to lower limb fracture and orthopedic treatment, known as the Qiao's spatial frame technology [10-11]. Considering the large size of the digital six-axis external fixator, Professor Qiao Feng further developed a digital six-axis external fixator-assisted reduction and unilateral external fixator technology for the treatment of tibial shaft fractures. The developed unilateral external fixator is small in size, can be coupled with the six-axis external fixator, and is relatively less expensive than similar external fixators such as the Taylor spatial frame. The purpose of this study was to retrospectively compare the digital six-axis external frame and the digital six-axis external frame-assisted reduction with unilateral external fixator for the treatment of tibial shaft fractures, and to evaluate the efficacy of the latter.
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ZHANG Ji, QIAO Feng, LU Yufeng (2026). Digital six-axis external frame assisted unilateral external fixator for treatment of tibial shaft fractures: achieving anatomical reduction and stabilization. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21617
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Frequently Asked Questions
What is the Qiao's spatial frame?
The Qiao's spatial frame is a digital six-axis external fixator technology designed by Professor Qiao Feng at Xi'an Honghui Hospital. It is based on CT data, allowing precise fracture reduction, and is used for lower limb fractures and orthopedic treatment.
How does the Qiao's frame assisted unilateral external fixator technique work?
This technique couples the digital six-axis external frame with a unilateral external fixator. The six-axis frame assists in achieving anatomical reduction, while the unilateral fixator provides stable fixation with a smaller size and lower cost compared to traditional ring fixators.
What are the advantages of the Qiao's frame assisted unilateral external fixator over traditional external fixators?
The technique reduces the volume and complexity of traditional ring external fixators, lowers nursing burden, and decreases the incidence of pin tract complications, while maintaining effective fracture reduction and stabilization.
What were the main findings of the study?
The study found no significant differences in fracture displacement, healing time, or functional scores between the Qiao's frame group and the Qiao's frame + unilateral external fixator group, but the latter had significantly fewer cases of pin tract traction pain, indicating a lower complication rate.
What are the limitations of the study?
The study was retrospective and non-randomized, which may affect the rigor of efficacy evaluation. Future research should include prospective randomized controlled trials, larger sample sizes, multicenter data, and patient-reported outcomes to further validate the technique.
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