Limb reconstruction service

Our services

The Limb reconstruction service treats a wide variety of conditions including complex trauma, bone infection, post-traumatic deformities, limb and joint reconstruction, and limb lengthening.

This service covers a wide range of patients from those who have sustained major trauma to limb lengthening.

This includes the use of fine wire frames, Precice nails and cabling systems.

It can be accessed directly through admission to the Major Trauma Centre or via a complex lower limb referral from another centre.

The service works closely with the bone infection team and collaboratively with the wider multidisciplinary team based at Addenbrooke’s Hospital.

Inpatients

Ward D8, Level 8

01223 245151

Outpatients

Clinic 1, outpatients level 2

01223 245151

Information for patients

Limb reconstruction clinics run on Tuesday mornings and Friday afternoons.

Newly referred patients will typically be seen by the team to perform an initial assessment. Patients requiring treatment with a fine wire frame receive individualised teaching on the proposed treatment plan and how to adapt to a fine wire frame from the clinical nurse specialist in clinic, or on the inpatient ward (depending upon their treatment pathway). The patient is given a written information book and provided with contact details for the limb reconstruction team. They will also receive an exercise programme from the physiotherapy team who will also review them regularly post-operatively and in clinic alongside the rest of the team.

The Consultant will explain the treatment plans and answer all questions. He will consent them in clinic for planned procedures and he or the clinical fellow will do this on the wards if they are still in-patients from sustained trauma injuries. If the patient is consented in clinic we ask that they bring the consent form with them on the day of surgery to avoid delays.

If the patient has sustained a recent traumatic injury and had skin grafts with the plastic surgical team, they will either have internal fixation with metalwork or have a temporary external fixator applied for their bony injury. This is then removed after the grafts have healed, normally approximately four weeks later. This will be done in theatre and a fine wire frame applied if they have extensive bone loss or significant deformity which could not be treatment with internal fixation.

Admission is normally on the day of surgery, they will be contacted a few days before by the trauma co-ordinators or the bookers to ensure that they know where to go and when to be nil by mouth.

It is advisable to bring loose clothing and if they are having a fine wire frame or external cabling trousers with side openings are easiest.

Please bring sensible walking shoes and firm, well supported slippers to make mobilisation easier.

After the operation the surgical team will come and review and discuss the operation. Mobilising starts the next day and it is important that this starts as soon as possible to avoid joint stiffness. There is often an X-ray but you can mobilise before this and the team will advise you whether or not you can put weight through the operated limb.

If the treatment is using a fine frame a post -operative X-ray is done and the clinical nurse specialist will give the patient a frame prescription and teach how to do the frame adjustments and look after the pin sites. She will review daily and also teaches friends/ family members/carers on how to look after the frame and do all adjustments as required.

If the treatment is a Precice nail the clinical nurse specialist will review and explain how this system works and how to use the magnets. She will also provide contact numbers and written instructions on application.

The physiotherapists will review regularly whilst in hospital and give an exercise plan. It is extremely important that this is followed throughout the treatment in hospital and on discharge to reduce the risk of potential complications.

For fine wire frame patients: once they are safely managing their fames and independently mobile we will discharge home or repatriate to local hospital if more support is required.

For patients with cables for limb lengthening once the patient can safely manage all cable adjustments, pin-site care and are mobile they will be discharged home.

Patients with Precice nails can often go home one day post-surgery, once they are happy using their magnets for limb lengthening and safely mobilising independently.

For patients with bone infections there is also extensive input and support from the bone infection team. The treatment will be discussed with the team, they will regularly review throughout the hospital stay prescribing individual antibiotic treatment plans in response to specimen and blood results.

In some instances patients may be required to remain in hospital until certain specimen and culture results are back

Patients may have antibiotics for longer periods of time but often this can be adapted for them to be able to go home as soon as possible, depending upon the infection. Either the patient or a designated family member will be taught to give the antibiotics intravenously (through a line in the arm) if they can manage or we will arrange for this to be given by the specialist team. During this period require regular bloods may be required and this is also sorted out by the bone infection team.

The patient will have regular out- patient appointments which will be sent to them through the post and clinics are on Tuesday mornings and Friday afternoons. Often X-rays are needed before seeing the team and if they have fine wire frames a new frame prescription will be made and given in clinic, with frame adjustments made as needed.

If transport is needed to attend these clinics this is arranged through the patient’s GP surgery, so please contact them to arrange this.

Patient support links

www.limbreconstruction.com

Patient Information following application of an external fixator: patient.information@addenbrookes.nhs.uk

Patient support group for patients with fine wire frames

Monthly meetings on a Friday lunchtime.

For more information please email: davidmargylewis@gmail.com