King's College Hospital Limb Reconstruction Trust was set up to support the large number of patients with congenital and acquired limb deformity who are treated at the hospital's Limb Reconstruction Unit. Treatment for such deformity is often prolonged and requires a good deal of courage.
The unit also looks after many patients with fractures that will not heal with first line treatment and who often suffer greatly. Typically these patients are often men in heavy physical jobs, soldiers on active service, and motorcyclists. Most are aged 20 to 50. The most common fractured bone in this group of patients is the tibia (shin bone) due to relative exposure and poor soft tissue cover.
Treatment is painful and can take many months or even years, with multiple operations frequent. Job losses, financial pressure, loss of mobility and breaking relationships are all too common. Inability to walk or drive leads to reduced independence, and increasing reliance on others. Loss of self-esteem is not surprising, and clinical depression follows in some cases.
Patients in this group have overall scores of patient well-being (such as the SF36 and NHP) showing consistently very poor results.
King’s College Hospital Orthopaedic Department has six surgeons with a stated interest in poorly healing fractures, and four of these also carry out deformity correction. There is tertiary referral pattern (referrals from other hospitals) from the whole of South East London, Kent and Sussex as well as some from further afield.
This Limb Reconstruction Service calls on the expertise of these surgeons, but also on one full-time specialist nurse, one full-time specialist physiotherapist, specialised theatre staff and equipment, and surgeons in training gaining insight into this emerging subspecialty.
Surgeons in this field from across the UK have a specialist society, under the auspices of the British Orthopaedic Association (BOA), called the British Limb Reconstruction Society (BLRS). Four of the surgeons at King’s are members of this society. The BLRS organises annual meetings to discuss issues relating to this field, and present papers from similar centres.
King’s Orthopaedic Department, as one of the busiest tertiary units in the UK, was an ideal base to set up the charity. We have received considerable support from the surgeons and patients, and from many volunteers.