Coping with a frame

 

Being fitted with a frame can be debilitating. Some people can go from being fairly mobile, depending on the extent of their injury or deformity, to being unable to move around without crutches or a wheelchair. Your mobility will also be affected by the size of your frame and its location. Some people even require more than one frame at the same time.

You will find that wearing a frame will affect you physically and psychologically. You have to deal with what led you to having a frame fitted in the first place. Once the frame is on you have to contend with the reactions of other people and being an object of curiosity.

Over time most people find that they can get around fairly well with a frame and you will be encouraged to use your limb as much as possible, particularly once it is in its corrected position. You will also be given instructions on physically managing your frame before you leave hospital and information about what to do if you need help once you are home.

You can find more information in this section of the website, as well as suggestion for how you can seek psychological support if you find the emotional aspects of being fitted with a frame difficult.

Pin site care What if things go wrong Adjusting struts Removing a frame All patients are taught how to look after pin sites before leaving hospital. Pin sites need to be cleaned to keep them free from infection and to stop them from weeping. Pin sites will weep for a while after surgery, but the aim of good pin site care is to stop them weeping as quickly as possible.

Different methods
There has been much debate about the best way to look after pin sites and many scientific articles have been written on the subject. In reality, there is little evidence to say that one system is better than another.

Some departments and surgeons say the pin sites should be covered daily and kept dry. There is also a debate as to whether the scabs should be removed. Other surgeons feel that clean, dry pin sites can be left open to the air.

Most surgeons do agree that a daily shower helps. This includes dousing the frame liberally with water. But whether you should use suds or not remains a subject for debate.

This conflicting information can be confusing for patients who may even get different instructions by the professionals who care for them. The main thing is to remember that there are many different approaches, and you should follow the routine that your surgeon recommends for you.

 

Limb Reconstruction Nurse, Debbie Bond, explains the KCH technique for pin site care to a patient in a Taylor Spacial Frame in this video:

KCH Limb Reconstruction Unit – Pin Site Care

Pins going through muscle tend to cause more problems than those going directly into bone. Particularly troublesome pins sometimes have to be removed. Others can be removed after they have done their work in the initial phase of the treatment.

If a pin area becomes increasingly painful, it is usually an indication that it has become infected. At KCH all patients are issued with a prescription of antibiotics to take if a pin site becomes infected.

 

 

If you are a KCH patient and think you have an infection you are encouraged to call the limb reconstruction nurse for advice, and take the antibiotics. If appropriate, you will also be given an appointment in the next weekly clinic. If the infection is severe we admit people to hospital for intravenous antibiotics (via a drip) and, rarely, to change the pin.

If you are not a KCH patient, you should contact your own medical team for advice.

KCH Limb Reconstruction Unit Nurse Debbie Bond explains the process for the adjustment of struts on a Taylor Spatial Frame in this videos:

Adjustment of Struts

Detail of strut adjustment

When struts in the frame become too long or short, they are changed for the next size. Nurse Debbie Bond talks through the process in this video:

Changing a strut in a TSF

These videos show the process of frame removal.

The struts are dynamised to see if the leg is strong enough to bear weight:

Dynamisation of struts

The patient walks on a dynamised frame to check that the bone is strong enough for the final removal of the frame

Walking on dynamised frame – final check before removal

The rings are removed.

Removal of rings

 

Once the rings are removed, the pin sites will bleed for a few hours, Dressings are applied, with instructions to remove after 48 hours.

Dressing of pin sites

 

With thanks to:

Mark Phillips, consultant orthopaedic surgeon and founder Chair and former trustee of KLRT.

Nurse Debbie Bond.

Patient John for nobly sharing his experience.