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 the external fixator. If the bones are being treated, then the surgeon will also perform an osteotomy (surgical division of the bone), carefuly 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 happy that the correct positon 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 a deformity has been corrected the frame is fixed in that position. There are no more daily alterations. This stage usually takes a few months, allowing the bones to fix and strengthen and the muscles and other soft tissue to become established at their new reach.
If you are having limb reconstruction on your leg, the ease with which you walk and your walking pattern will both be affected.
Your 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.
Once you 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.
If you are having limb reconstruction on your arm, your physiotherapist will teach you exercises to help you take weight through it, once your surgeon is happy for you to do so.
Removing a frame
In younger patients the frame will be taken off in surgery under general anaesthetic, which is not automatically necessary for adults. The screws and wires can be removed with little or no discomfort.