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TL-HEX TrueLok Hexapod SystemTM (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.


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

Mechanical tests performed highlight the superiority of TL-HEX over other frames in the key features tested.
TL-HEX with its high frame stability, represents a time- and cost-saving solution for circular fixation.


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Independent clinical studies show that the

TL-HEX System is safe and effective

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.
Click here to open the article


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.
Click here to open the article

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.
Click here to open the article

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
Click here to open the abstract

The use of gradual correction with the TL-HEX external fixator in Blount’s disease.

Bone Joint Journal, 2014
Mare P, Thompson D.
Click here to open the abstract

A comparison of deformity correction capabilities in hexapod frame systems.

Journal of Limb Lengthening & Reconstruction 2016
Iobst CA, Samchukov M, Cherkashin A.
Click here to open the article

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.
Click here to open the abstract

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.
Click here to open the article

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.

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

TL-HEX is not simply a product. 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.

It provides education, support and resources to empower patients with a limb deformity and their families.

  • Description of limb deformities
  • Treatment options
  • Patient testimonials
  • Resources
  • TL-HEX description

Surgeon locator

An additional service to the patients, included on the website. It enables patients to find contact information for surgeons or specialists, by geographic area, authorized to use TrueLok/TL-HEX software.

Ask your sales reps for more details

Pre-surgery meeting brochure

Intended to be used during the pre-surgery meeting, as a guide to discuss the proposed surgery.

  • Infographic depicting the treatment as a journey
  • Answers to the most common questions and concerns

Thinking big for kids

A complete set of tools for kids of all ages, designed to help them face the treatment with a positive attitude, thanks to different games and fun activities.

  • Kit for kids 3-6 years old
  • “Tommy and Linda: The Power of Unity” comics
  • mySuperheroAcademy edugame

Ask your sales reps for free samples

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



A successful treatment with TL-HEX is not simply a matter of correct strut adjustment.
The TL-HEX patient is supported from the first day after surgery until the device removal, through all the treatment phases.

  • Strut adjustment reminders
  • Pin site reminders
  • Mood self-assessment
  • Insights to the treatment

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

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.