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Fractures fixed with rods and frames, by a consultant trauma surgeon.

Intramedullary nails inside the bone. External fixators outside it. A UK patient guide to the two ways acute long-bone, hip and pelvic fractures are stabilised - chosen for your fracture, not the surgeon’s habit.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private rod or frame fixation costs in the UK.

Emergency trauma is NHS-funded via the trauma pathway.

In short

£15,000–£22,000, home in 1–3 days.

Procedure Indicative range
IM nail - tibial shaft (closed) £15,000–£22,000
IM nail - femoral shaft (antegrade or retrograde) £18,000–£28,000
Cephalomedullary nail - hip (PFN-A/TFN-A/Gamma) £17,000–£25,000
IM nail - humerus £15,000–£22,000
External fixator - spanning (damage-control) £12,000–£20,000
External fixator - definitive tibial IIIB/C £20,000–£40,000
Paediatric flexible IM nail (TENs) £10,000–£16,000
Consultation only £250–£450

Prices vary by hospital, by the implant chosen (nail vs frame, standard vs long, cephalomedullary), by the anaesthetic and by whether staged surgery is planned. Complex polytrauma, damage-control and infected non-union cases are quoted individually.

The problem

The right implant, the right timing, the right rehab.

Fracture surgery is only as good as the choice of construct, the timing and the rehab plan. We make sure all three are set by a consultant who does this every week, not once a month.

  • Emergency vs elective

    Damage-control surgery in 24 hours, definitive fixation in 12–24 hours for isolated closed cases, sooner for open. Timing is not optional.

  • A rehab plan, in writing

    Weight-bearing status, boot removal, pin-site care and X-ray schedule - all agreed before you leave hospital.

When it helps

When a rod or a frame is the right step.

The fracture patterns we see most, plus the one red flag that means the theatre, not a clinic booking.

  • Tibial shaft fracture (closed)

    An IM nail is the gold standard for most closed and low-grade open (Gustilo I/II/IIIA) tibial shaft fractures - reamed, statically locked.

  • Femoral shaft fracture

    Antegrade IM nail via a trochanteric entry is the usual adult approach; retrograde is used for distal fractures or a floating knee.

  • Pertrochanteric hip fracture

    A cephalomedullary nail (PFN-A, TFN-A, Gamma) is preferred for unstable pertrochanteric patterns - has largely replaced the DHS here.

  • Humeral shaft fracture

    IM nail is one option - indication is debated versus ORIF plating; useful for pathological or segmental patterns, but shoulder pain is a real risk.

  • Open fracture (Gustilo IIIB/C tibia)

    Severe open tibial fractures often need a spanning external fixator initially, then either definitive ex-fix, nail or Ilizarov once soft tissues allow.

  • Polytrauma - damage-control surgery

    A temporary spanning ex-fix stabilises long bones and pelvis in the unstable, bleeding patient, allowing definitive fixation once physiology has recovered.

  • Paediatric femur or tibia (5–14y)

    Flexible titanium elastic nails (TENs) stabilise the fracture while respecting growth plates - a very different approach from adult rigid nails.

  • Red flag: compartment syndrome

    Disproportionate pain, pain on passive stretch, tense compartments - the 5 Ps. This is a same-day theatre emergency, not an outpatient referral.

Fixation options

A rod, a frame, or a hybrid.

What each construct actually is, and which fracture pattern it fits - a plain-English guide to what your consultant is choosing between.

  • Reamed, locked IM nail (tibia/femur)

    A titanium rod down the marrow canal, locked with screws at both ends. The workhorse for shaft fractures - protected weight-bearing on day one for many patterns.

  • Cephalomedullary nail (hip)

    A short or long nail with a lag screw or helical blade into the femoral head. First-line for unstable pertrochanteric hip fractures.

  • Antegrade humeral nail

    Entry through the top of the humerus, with careful rotator cuff protection. Useful for some shaft and pathological fractures - shoulder pain is a known trade-off.

  • Paediatric TENs

    Two curved titanium wires threaded up the canal, respecting the growth plate. Standard for femoral and forearm fractures in the 5–14 age group.

  • Monolateral external fixator

    Pins on one side of the limb connected to a bar (Hoffmann, Orthofix). Quick to apply - the classic damage-control tool for open long-bone fractures.

  • Ring/Ilizarov fixator

    Thin wires under tension held in rings around the limb. Used for severe open fractures, infected non-unions and complex tibial reconstruction.

  • Hybrid fixator

    Ring construct at the joint end with a monolateral bar down the shaft - for periarticular fractures where a plate would not survive the soft tissues.

  • Pelvic external fixator

    A temporising anterior frame for an unstable pelvic ring - after pelvic binder and, if needed, C-clamp. Definitive fixation follows once the patient is stable.

Safety and recovery

What to expect afterwards - honestly.

Rod and frame fixation is safe and well-established, but real complications exist. The ones worth planning for are infection, non-union, compartment syndrome, and the weight-bearing status you leave hospital with.

  • Infection - the risk depends on the wound

    IM nails in closed fractures ~1%. Pin-site colonisation in external fixators is 20–40%, deep infection 5–15%. Open fractures carry far higher rates - antibiotics and washout timing matter.

  • Non-union and delayed union

    5–15% depending on energy, smoking, diabetes and open grade. Delayed union is >6 months without healing, non-union >9 months. Both are watched for at 6, 12 and 24 week X-rays.

  • Compartment syndrome - the early red flag

    Disproportionate pain, pain on passive stretch, a tense limb, and the 5 Ps (pain, pallor, paraesthesia, pulselessness, paralysis). Suspicion is enough - call the team the same day.

  • Fat embolism after long-bone reaming

    Reaming a long bone can release marrow fat. Watch for breathlessness, low oxygen, confusion or a petechial rash in the first 24–72 hours - uncommon but taken seriously.

  • Weight-bearing is prescribed, not guessed

    Some IM nail patterns allow immediate weight-bearing under BOA guidance; others need touch- or toe-touch weight-bearing for 6–12 weeks. Your written plan makes it explicit.

  • Pin-site care for external fixators

    Weekly clinic checks, a simple daily cleaning routine (the NHS-endorsed protocol) and a low threshold to swab. Redness or discharge is called in, not left.

  • Hardware pain, removal and refracture

    Some patients need the nail or screws out later for pain. Refracture through the old fracture line is a small but real risk in the months after removal - we plan protected activity.

  • DVT, PE and stiffness

    Chemical thromboprophylaxis after long-bone or pelvic surgery, mechanical stockings, and early mobilisation. Adjacent joint stiffness (knee after tibial nail) is treated with physio.

  • Red flags after discharge

    Fever, spreading redness, worsening pain, calf swelling, breathlessness, or the wound opening - call the team or A&E the same day, do not wait for the next clinic.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever construct was used, the note the surgeon sends you keeps to the same shape.

A UK consultant trauma surgeon reviewing a patient’s operation notes

A quiet reminder

Trauma language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the note before your review, just ask.

  1. 01 Header

    Fracture, energy and soft tissues

    Which bone, the AO/OTA classification, whether it was closed or open (Gustilo grade), and the mechanism - this drives every later decision.

  2. 02 Technique

    Fixation chosen and why

    IM nail vs cephalomedullary nail vs external fixator, entry point, reaming, lock configuration, and - for ex-fix - pin sites and frame construct.

  3. 03 Findings

    Reduction quality and intra-op X-rays

    How the fracture was reduced, whether alignment and rotation are acceptable on the image intensifier, and any incidental findings.

  4. 04 Impression

    Weight-bearing, follow-up, red flags

    Read this first: your weight-bearing status, when the next X-ray is, when to move a boot or cast, and the symptoms that mean you call the team.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Emergency trauma is NHS-funded via the trauma pathway.

Frequently asked

Everything we get asked about rod and frame fixation.

Quick answers on nails vs frames, weight-bearing, healing times, complications and hardware removal.

  • What is the difference between a rod and a frame?

    A rod (intramedullary nail) sits inside the bone canal and is locked in place with screws - it is internal and largely hidden. A frame (external fixator) sits outside the skin, connected to the bone by pins or wires. Rods are the usual choice for closed shaft fractures. Frames are chosen when the soft tissues, contamination or fracture pattern make an internal implant unsafe.

  • Is an IM nail the gold standard for tibial shaft fractures?

    Yes, for most closed and low-grade open (Gustilo I, II and many IIIA) tibial shaft fractures in adults. It gives reliable healing rates, allows early weight-bearing in many patterns, and follows BOA guidance. Severe open fractures (IIIB/C) may need a frame instead, at least initially.

  • Why is a cephalomedullary nail used for hip fractures instead of a DHS?

    For unstable pertrochanteric patterns - reverse oblique, subtrochanteric extension, or multi-fragmentary - a cephalomedullary nail (PFN-A, TFN-A, Gamma) gives more reliable fixation than a dynamic hip screw (DHS). The DHS is still used for stable intertrochanteric fractures in many units.

  • How much does private trauma surgery cost in the UK?

    Roughly £15,000–£22,000 for a tibial IM nail, £18,000–£28,000 for a femoral nail, £17,000–£25,000 for a cephalomedullary hip nail, and £20,000–£40,000 for a definitive external fixator on a severe open tibia. Emergency trauma is NHS-funded via the trauma pathway - private is for elective or complex secondary work.

  • When can I put weight on the leg after an IM nail?

    It depends on the fracture. Many stable, statically-locked tibial and femoral nails allow immediate weight-bearing under BOA guidance. Comminuted or unstable patterns may need touch- or toe-touch weight-bearing for 6–12 weeks. Your operation note will state exactly what is allowed.

  • How is an external fixator looked after at home?

    You follow a simple daily pin-site cleaning routine (the NHS-endorsed protocol), keep the pins dry, and attend weekly clinic reviews. Redness, discharge, loosening of a pin or new pain is reported the same day - pin-site infection is common and easier to treat early.

  • When does a fracture heal, and what counts as non-union?

    Union is usually 12–24 weeks depending on the bone, the energy and the patient. Delayed union is generally >6 months without healing on X-ray; non-union is >9 months. Smoking, diabetes and open fractures all slow things down and are watched for.

  • What is compartment syndrome, and why does it matter?

    It is a surgical emergency after high-energy long-bone fractures - rising pressure inside a muscle compartment cuts off blood supply. The warning signs are disproportionate pain, pain on passive stretch, and the 5 Ps (pain, pallor, paraesthesia, pulselessness, paralysis). It needs same-day theatre for fasciotomy - never wait.

  • Will the metalwork stay in forever?

    For most adults, yes - a well-tolerated nail or plate is left in place. Removal is considered for hardware pain, prominence or infection, and is routine in children after healing. Refracture through the old fracture line is a small but real risk after removal, so activity is protected for a few months.

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