Abstract:[Objective] To compare the clinical efficacy of the Hexapod External Fixator (HEF) with the Unilateral External Fixator (UEF) in the treatment of open tibial fractures. [Methods] A retrospective analysis of 123 patients with open tibial fractures surgically treated in our hospital from June 2017 to September 2019, 72 with HEF and 51 with UEF according to the results of doctor-patient communication. [Result] All patients in both groups successfully completed the surgery and were effectively followed up for 25 to 32 months, with a mean of (26.50 ± 1.31) months. The number of postoperative stent adjustments in the HEF group was less than that in the UEF group (P<0.05), but the cost of surgery was higher than that in the UEF group (P<0.05). The differences in operative time, number of intraoperative fluoroscopy, time to stand on the ground and hospital stay were not statistically significant between the two groups (P>0.05) Over time, knee and ankle flexion and extension ROM of the affected limbs improved significantly in both groups (P<0.05). The clinical healing time of the HEF fracture and the time with the frame were earlier than those of the UEF group (P<0.05). The comparison of J-W rating, claudication and squatting between the two groups at the last follow-up was not statistically significant (P>0.05). Imaging assessment: the quality of fracture reduction gradually improved in both groups over time (P<0.05), and the quality of fracture reduction was better in the HEF group than in the UEF group at the last follow-up (P<0.05). The HKA, MPTA, and mLDTA angles improved significantly in both groups (P<0.05), and the correction of HKA, MPTA, and mLDTA angles of the affected limb was better in the HEF group than in the UEF group at the last follow-up (P<0.05). Fracture healing time was earlier in the HEF group than in the UEF group at shrinkage (P<0.05). [Conclusion] The application of HEF for open tibial fractures can better improve the quality of fracture repositioning and lower limb force line angle, and shorten fracture healing and bracing time.