Limb reconstruction · UK
External frames for bone deformity correction, by a BLRS reference-centre surgeon.
Ilizarov rings, Taylor Spatial Frame, TrueLok, Orthex, monolateral rails and Precice internal nails — for congenital deformity, malunion, non-union, bone loss and limb lengthening. Planned and delivered where UK limb reconstruction is actually done.
Why patients choose us
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BLRS reference-centre surgeons only
External frames are a subspecialty. We only introduce you to consultants who work at British Limb Reconstruction Society reference centres — Stanmore, Oxford, Leeds, Cardiff, Newcastle.
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Frame vs internal nail — the honest call
For many isolated lengthenings a Precice intramedullary nail spares you the external hardware. We say so before you commit to a ring frame.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private external frame costs in the UK.
Indicative ranges across BLRS reference-centre surgeons. Send the details and we quote firm figures across two or three options.
In short
A single-segment Taylor Spatial Frame in our network: £28,000–£48,000, frame time 6–12 months.
| Procedure | Indicative range | Typical theatre time | Frame / union time |
|---|---|---|---|
| Taylor Spatial Frame (hexapod) — single segment | £28,000–£48,000 | 2–4 h GA | 6–12 mo frame time |
| Ilizarov ring frame — single segment | £24,000–£42,000 | 2–4 h GA | 6–12 mo frame time |
| Monolateral / rail fixator (LRS) | £18,000–£32,000 | 90–150 min | 4–9 mo frame time |
| Bone transport for segmental loss (hybrid frame) | £38,000–£65,000 | 3–5 h GA | 9–18 mo frame time |
| Precice intramedullary lengthening nail | £26,000–£42,000 | 2–3 h GA | 4–8 mo to union |
| Consultation and deformity analysis | £300–£550 | 45–60 min | Same visit |
Prices vary by centre, by which surgeon does the case, by the complexity of the deformity, and by whether internal Precice nailing, bone graft or antibiotic beads are needed. We come back with a firm quote within one working day.
The problem
The right frame, the right surgeon, the right centre.
Limb reconstruction is a subspecialty of a subspecialty. General orthopaedic surgeons do not do enough frames to be excellent at them — outcomes depend on volume, planning software, and a nurse-led pin-site service.
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Frame or internal nail?
For many isolated lengthenings a Precice intramedullary nail avoids external hardware entirely. We say so before you commit to a ring.
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Which frame system?
Taylor Spatial Frame, Ilizarov, TrueLok, Orthex or monolateral rail — the choice turns on the deformity, not on what the surgeon has in the cupboard.
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Which centre?
BLRS reference centres — Stanmore, Oxford, Leeds, Cardiff, Newcastle — do most of the UK’s complex work. Choose one of them.
The journey
From enquiry to frame removal — what happens, in order.
One surgeon from first message to frame removal — including the months of distraction and consolidation in between.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
2–4 nights in hospital
Phase 3 · After
6–18 months in the frame
- 01
Before
You tell us what is going on
Congenital deformity, malunion, non-union, bone loss after infection or tumour, or a leg-length difference — a short, confidential form.
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Before
We come back with a recommendation
Within one working day: which frame or nail fits, whether a hexapod (Taylor Spatial Frame) or Ilizarov ring or monolateral rail is right, and an indicative price.
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Before
Templating and planning
CT scanogram or EOS long-leg imaging, deformity analysis on the surgeon’s planning software, and a written frame prescription — before you go anywhere near theatre.
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On the day
Frame application in theatre
A 2–4 hour operation under GA. Rings, half-pins and wires are placed, the corticotomy (bone cut) is made, and the frame is dressed.
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On the day
Inpatient stay 2–4 nights
Pain control, first physio, pin-site care teaching, and the SpatialFrame.com adjustment schedule handed over on paper and by email.
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After
Latency, distraction, consolidation
5–7 day latency, then ~1 mm/day distraction (four turns of 0.25 mm) for weeks to months, then 2–3× that time consolidating. Frame time is typically 6–18 months.
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After
Frame removal and rehab
Removal in theatre or clinic once the regenerate is solid on X-ray, followed by protected weight-bearing and structured physiotherapy.
Typical end-to-end: 2–4 weeks from enquiry to frame application. Frame time: 6–18 months.
When it helps
When an external frame is the right step.
The indications we see most, plus the red flags that mean an emergency rather than a clinic appointment.
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Congenital deformity
Angular, rotational or length differences present since childhood — often in tibia, femur or forearm.
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Post-traumatic malunion
A previous fracture that healed in the wrong position, leaving a bent, shortened or rotated bone.
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Non-union of a fracture
A fracture that has not healed after months — a frame provides stability and biology for union.
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Infected non-union with bone loss
Segmental bone loss after osteomyelitis or open fracture, managed by bone transport across a frame.
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Limb lengthening
For achondroplasia, hemi-hypertrophy, or cosmetic stature change — via ring frame or an internal Precice nail.
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Limb salvage after tumour resection
Reconstructing a segment of bone removed for a benign or malignant tumour, often with bone transport.
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Ankle and foot deformity (Charcot)
Complex hindfoot and midfoot correction in diabetic Charcot arthropathy where internal fixation would fail.
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Red flag: open fracture, fever
A new open fracture, spreading redness around pins, or fever with a frame in situ is not a clinic booking — go to A&E the same day.
Frame options
Not every frame is a ring frame.
What each option actually involves — hexapod, ring, rail, hybrid, hinged, transport, or an internal Precice nail — and which fits which problem.
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Taylor Spatial Frame (TSF)
A hexapod ring frame with six struts. A computer-generated schedule (SpatialFrame.com) tells you which strut to turn each day — precise 6-axis correction.
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Ilizarov ring frame
The original ring fixator using threaded rods. Adjustments are made by hand at 1 mm/day in four increments — the biology that underpins every modern frame.
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TrueLok and Orthex hexapods
Modern alternatives to the TSF — hexapod ring frames with vendor-specific planning software. Choice usually turns on which system the surgeon uses.
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Monolateral rail fixator (LRS)
A single-sided rail with half-pins — lower profile than a ring, easier for the patient, but limited to simpler corrections and shorter segments.
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Hybrid ring + monolateral
A combined construct where a ring is used at one end and a rail at the other — often for tibial plateau or peri-articular corrections.
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Precice / STRYDE intramedullary nail
A magnetically driven internal lengthening nail — no external hardware. The patient uses an external remote controller daily. Superseded frames for many isolated lengthenings.
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Hinged frame for joint contracture
A ring frame with a hinge across a stiff joint — gradual distraction across the joint releases contracture without an open procedure.
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Bone transport frame
A ring frame that moves a segment of bone across a gap — used for infected non-union, tumour defects, and open-fracture bone loss.
Our vetted UK network
A small panel of limb-reconstruction consultants, we picked them.
Consultants working at BLRS reference centres — Royal National Orthopaedic Hospital (Stanmore), Nuffield Orthopaedic Centre (Oxford), Leeds General Infirmary, University Hospital of Wales (Cardiff), and the Freeman Hospital (Newcastle).
Selection criteria
How we choose every surgeon in our network.
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Consultant limb-reconstruction surgeons at BLRS reference centres
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Full hexapod and Ilizarov capability, plus Precice internal nailing
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Nurse-led pin-site care to the NMC-endorsed protocol
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Multidisciplinary input — physiotherapy, pain, plastics, psychology
Safety and recovery
What to expect over the next 6 to 18 months — honestly.
External frame treatment is long, demanding, and the results are worth it — but only if the pin-site care, the physiotherapy and the mental-health support are in place from day one.
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Pin-site infection is nearly universal
Almost every patient has at least one pin-site infection over 6–18 months. Most settle with oral antibiotics; deep infection at 5–10% needs pin exchange or IV antibiotics.
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Distraction is slow, and it must be
Standard rate is 1 mm/day in four turns. Faster risks non-union of the regenerate; slower risks premature consolidation. The schedule is not negotiable.
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Joint stiffness and contracture
Adjacent joints — knee, ankle, elbow — stiffen over months in a frame. Physiotherapy 2–3×/week throughout is not optional.
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Neurovascular injury at pin insertion
Rare but real. Frames are placed to published safe corridors and, where needed, under ultrasound or image intensifier control.
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Refracture after frame removal
The new bone (regenerate) is not fully mature at removal. A protective cast or brace and graduated weight-bearing reduce refracture risk.
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DVT and mobility
Reduced mobility raises clot risk. Prophylaxis and early walking with the frame in situ are standard.
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Driving is usually not possible
Most patients cannot drive with a lower-limb frame in situ. Confirm with your insurer and surgeon before assuming otherwise.
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Mental-health burden is real
A 6–18 month treatment is long. CBT, peer support and a named clinical psychologist reduce dropout — we build them in from the start.
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Red flags
Fever, spreading redness beyond a pin site, sudden pain, or a loose pin are not normal — call the team or A&E the same day.
Reading your frame prescription
Your frame plan in four parts. Read the last one first.
Whichever frame is chosen, the paperwork the surgeon sends you keeps to the same shape.
A quiet reminder
The SpatialFrame.com schedule is precise — and easy to misread. We translate it for you.
If you would like us to talk you through the daily turns before you start distraction, just ask.
- 01 Header
Diagnosis, plan and frame type
What is being corrected — deformity, non-union, bone loss, lengthening — and which frame or nail was chosen.
- 02 Technique
Operation note and construct
The corticotomy level, ring and pin positions, wire tensions, and any bone graft or antibiotic beads used.
- 03 Findings
Adjustment schedule and X-ray plan
The SpatialFrame.com prescription (which strut to turn, when, by how much), and the interval between clinic and X-ray reviews.
- 04 Impression
Milestones, driving, work, removal date
Read this first: latency to distraction, expected consolidation, work adaptation, and the target frame-removal window.
Recognised by major UK insurers
Cover for limb reconstruction varies by insurer and by indication — usually funded when medically indicated (trauma, non-union, congenital), self-pay for stature or cosmetic lengthening. Prolonged-treatment compensation payments are sometimes considered. We confirm cover before booking.
Frequently asked
Everything we get asked about external frames.
Quick answers on frame vs nail, pin-site care, driving, work, and how long the whole thing really takes.
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What actually is an external frame?
A metal ring or rail sitting outside the leg or arm, fixed to the bone through the skin by wires and half-pins. It holds the bone rigid while you turn small screws each day to slowly lengthen, straighten or transport it. It is based on the Ilizarov principle: 1 mm per day, in four 0.25 mm increments, so new bone (regenerate) fills the gap.
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Ilizarov, Taylor Spatial Frame, TrueLok, Orthex — what is the difference?
Ilizarov is the original ring fixator with threaded rods, adjusted by hand. TSF, TrueLok and Orthex are all hexapod ring frames — six struts driven by a computer-generated schedule (SpatialFrame.com for the TSF) that lets the surgeon correct all six axes of deformity at once. The biology is identical; the correction maths is more elegant.
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Could I have an internal nail instead of an external frame?
Sometimes yes. The Precice (and previously STRYDE) intramedullary lengthening nail is magnetically driven from a remote unit — no external hardware, less pin-site care, quicker return to work. It suits isolated femoral or tibial lengthening in adults with straight bones and healthy soft tissue. It cannot replace a frame for infected non-union, bone transport, hinged joint distraction, or complex multi-axis deformity.
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How long will I have the frame on?
Typically 6 to 18 months. Frame time roughly equals the distraction phase (about 1 cm per month) plus 2–3× that time consolidating. A 5 cm lengthening therefore usually means 5 months of turning plus 10–15 months in the frame overall.
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What is the SpatialFrame.com schedule?
When your surgeon prescribes a Taylor Spatial Frame correction, they enter your deformity and construct into SpatialFrame.com. The software returns a day-by-day prescription — which of the six struts to turn, by how much, on which day. You are given a paper schedule and daily reminders; the whole correction takes weeks to months.
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What is pin-site care and does it really matter?
The wires and pins pass through skin, so infection is nearly universal — most cases settle with oral antibiotics. The NMC-endorsed UK pin-site care protocol (cleaning with chlorhexidine, low-linting dressings, weekly review) reduces deep infection to around 5–10%. Skipping care is the commonest reason frames get into trouble.
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Can I work and drive with a frame on?
Office work, yes — many patients return within 2–6 weeks and work from home during distraction. Manual work usually waits until frame removal. Driving with a lower-limb frame is not normally possible; check with your surgeon and motor insurer before assuming otherwise.
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How much does a private external frame cost in the UK?
Roughly £28,000–£48,000 for a Taylor Spatial Frame single-segment correction, £24,000–£42,000 for an Ilizarov, £18,000–£32,000 for a monolateral rail, and £38,000–£65,000 for bone transport across a segmental defect. An internal Precice nail is £26,000–£42,000. All figures include theatre, implants, and the first months of follow-up.
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Where in the UK is this best done?
The BLRS (British Limb Reconstruction Society) reference centres are the safest choice — the Royal National Orthopaedic Hospital at Stanmore, the Nuffield Orthopaedic Centre in Oxford, Leeds General Infirmary, University Hospital of Wales in Cardiff, and the Freeman Hospital in Newcastle. We only introduce you to consultants who work at one of these.
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