“Rebuild helped me back to daily life, step by step”

What is limb reconstruction?
Limb reconstruction is a term that covers all sorts of treatments for injured or deformed limbs, many of them using external fixators. These are external frames fixed to the underlying bone using wires or pins. Once in place they can be used to lengthen or shorten a limb, bring a fracture into alignment, correct a deformity or replace missing bone.

Limb reconstruction is a long, drawn-out process that can last over a year and it can be another year before you start to feel the real benefits. However, it can heal fractures that have stubbornly refused to respond to other treatment and help limb deformities, so vastly improving your mobility.

Successful limb reconstruction surgery can really feel like a miracle cure but it is not an easy choice. People going through this surgery often have severe emotional, physical, financial and practical problems. A very few patients conclude that this arduous prolonged treatment is not for them and make the difficult decision to have an amputation.

How it works Limb reconstruction
within the NHS
Glossary of medical terms History
An external fixator (frame) is applied to the limb in surgery. Frames can be used to stretch and/or lengthen limbs. A surgeon makes a tiny incision in the bones, pushes the pins through the bones and attaches them to an external fixator. If the bones are being treated, then the surgeon will also perform an osteotomy (surgical division of the bone), carefully preserving the soft tissue attachments and blood supply to the area. The limb is now at a point where it can be gradually corrected at home by the patient, who turns a screw or a nut on the frame. The surgeon gives precise instructions about how far the frame should be adjusted each day. The gaps in the bone that are created by adjusting the frame are filled in by the patient growing new bone.

Patients have regular x-rays and reviews until the surgeon is satisfied that the correct position has been achieved. If the limb is stretched too far or over-corrected, the surgeon can alter the daily instructions in the opposite direction.

Fixing the position
Once the deformity has been corrected, the frame is fixed in that position. There are no more daily alterations. This stage usually takes a few months because the bone can only be lengthened by 1mm per day allowing the bones to fix.

Getting around
If you are having limb reconstruction on your leg, the ease with which you walk and your walking pattern will both be affected.

The physiotherapist on the ward will let you know how much weight you are allowed to put through your leg. This is different for each patient. If necessary, the physiotherapist will also teach you how to walk with a walking aid (such as a rollator frame, or elbow crutches) and use the stairs.
Bone stimulation
It is possible to speed up bone healing using electromagnetic or ultrasound machines.

At KCH we use Low Intensity Pulse Ultrasound (LIPUS) for some patients.

These machines seem to have about a 70% success rate in healing non-unions over three months, but the research date in this area is still relatively poor.


If you are having limb reconstruction on your arm, your physiotherapist will teach you exercises to help you take your weight through it, once your surgeon is happy for you to do so.

Once your are allowed to put weight through your affected leg, your physiotherapist will teach you exercises to help you walk and also work with you on your walking pattern.

Removing a frame
In younger patients the frame will be taken off in a surgery under general anaesthetic but, for adults, this can sometimes be done in clinic where the pins and wires can be removed with little or no discomfort.
For the NHS, the Limb Reconstruction Service brings to an end the cycle of prolonged morbidity, multiple interventions and conspicuously large consumption of NHS resources, It is undoubtedly a cost limiting service. For the economy, the Limb Reconstruction Service restores working age adults to the workforce. What is the demand for the Limb Reconstruction Service?
Demand is growing, with the annual number of referrals rising from 40 in 1996 to almost 200 in 2017.

Why are numbers increasing?
Patients who have been previously advised to accept disability are now more aware of reconstructive possibilities; also there is a greater awareness of the service at KCH.
Is demand likely to change?
The trend is clearly increasing. Changes in the training of orthopaedic surgeons, which will be shorter in training posts and hours spent per year, will mean that complex trauma will be referred to specialist centres much more frequently. KCH is already experiencing this with the establishment of the Major Trauma Unit (MTU).

Patient expectations change and increase all the time. Disability that was formerly accepted is now accepted much less often. Awareness of reconstruction techniques is more widespread and more information is available on the internet.
Glossary of medical terms BMP
Bone Morphogenic Proteins. to accelerate bone growth

Catheter
Fine tube

CBT
Cognitive Behavioural Therapy

Compartment Syndrome
Rare build-up of pressure in the leg or forearm

Distraction
Slow steady tension to injured tissue

Epidural
Spinal anaesthetic

External fixator
External frame fixed to the bone using wires (or pins) and screws

Histogenesis
Creating new tissue

LFUD
Low frequency ultrasound devices, to stimulate bone growth

LIPUS
Low Intensity Pulse Ultrasound device. to stimulate bone growth

KCH
King’s College Hospital

MTC
Major Trauma Centre

Non-union
A fracture that will not heal without further intervention

Osteotomy
Surgical division of the bone

PCA
Patient-controlled analgesia

PEMF
Pulsed EIectroMagnetic Field. to stimulate bone growth

PICC
Peripherally Inserted Central Catheter. a thin, soft. long tube inserted for long-term intravenous antibiotics and taking blood

Proprioception
The brain’s awareness of a joint‘s or limb's position in relation to the rest of the body

Tertiary healthcare
Specialised consultative care, usually on referral from primary or secondary medical care personnel. by specialists working in a centre that has personnel and facilities for special investigation and treatment

TSF
Taylor Spatial Frame, external device for limb correction
Limb reconstruction, as a speciality, is generally attributed to Ilizarov, a Russian Jew who worked in isolation in Krugan, a city east of the Urals, from the late 19405 until his death around 1990. He developed techniques for creating new tissues (histogenesis) using an apparatus which applied slow steady tension (distraction) to injured tissues. He discovered a new biological principle (the Law of Tension Stress) by means of which adult cells could create new tissue. His work was the first example of what we might call tissue engineering.

His patients were the war wounded of whom there were huge numbers. His astonishing work was not widely known in Russia until it was almost fully developed and reach the West. via Italy, in the late 19705. It was adopted in the UK in the late 19805. lIizarov techniques were first used at King's in 1993. Other techniques are also used in the Limb Reconstruction Service, but the service has come to be defined by the llizarov method.

For the NHS. the Limb Reconstruction Service brings to an end the cycle of prolonged morbidity. multiple interventions and conspicuously large consumption of NHS resources. It is undoubtedly a cost limiting service. For the economy, the Limb Reconstruction Service restores working age adults to the workforce.
What is the demand for the Limb Reconstruction Service? Demand is growing, with the annual number of referrals rising from 40 in 1996 to almost 200 in 2017.

Why are numbers increasing?
Patients who have been previously advised to accept disability are now more aware of reconstructive possibilities; also there is a greater awareness of the service at KCH.

ls demand likely to change?
The trend is clearly increasing. Changes in the training of orthopaedic surgeons. which will be shorter in training posts and hours spent per year. will mean that complex trauma will be referred to specialist centres much more frequently. KCH is already experiencing this with the establishment of the Major Trauma Unit (MTU).

Patient expectations change and increase all the time. Disability that was formerly accepted is now accepted much less often. Awareness of reconstruction techniques is more widespread and more information is available on the internet.