Limb Reconstruction

Limb reconstruction is a specialist area of orthopaedics that focuses on treating complex problems of the arms and legs, particularly where there is damage or deformity of bone, joints, soft tissue, or a combination of these. It is commonly used after major injury, complications following surgery, infection, non-healing fractures, or long-standing deformity.

The aim of limb reconstruction is to restore function, alignment, length and stability, reduce pain, and improve mobility and quality of life.

At the Royal Buckinghamshire Hospital, we provide consultant-led assessment and can coordinate the appropriate investigation and onward pathway for complex limb reconstruction care where required.

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Types of Limb Reconstruction

Limb reconstruction may involve one or more of the following areas:

• Non-union and delayed union surgery
  Treating fractures that are not healing properly.
• Malunion correction
  Correcting bones that have healed in the wrong position.
• Deformity correction
  Addressing bowing, angulation, rotational problems, or limb alignment issues.
• Limb lengthening or shortening procedures
  Managing limb length discrepancy following injury, childhood conditions, or surgery.
• Complex revision surgery
  Revision of previous operations where outcomes have been complicated by instability, infection, or mechanical failure.
• Bone infection management (osteomyelitis)
  Treatment planning for chronic infection affecting bone and surrounding tissues.
• Soft tissue reconstruction coordination
  Planning where skin, muscle, tendon or nerve repair is needed alongside bone work.
• Joint preservation procedures
  Where possible, aiming to preserve a joint rather than proceeding directly to joint replacement.

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Common Reasons for Limb Reconstruction

Limb reconstruction may be considered for:

• Complex fractures, especially after road traffic incidents or falls from height
• Bone that has not healed (non-union) or is healing slowly (delayed union)
• Bone healing in the wrong position (malunion), leading to pain or poor function
• Limb length discrepancy affecting walking and posture
• Complications after orthopaedic surgery (instability, failure of fixation, recurrent deformity)
• Bone infection (osteomyelitis) or infection around hardware
• Deformity caused by arthritis, childhood conditions, or previous injury
• Severe joint damage where joint preservation may still be possible

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Symptoms that may indicate a limb reconstruction problem

Symptoms depend on the underlying issue, but may include:

• Persistent pain at a fracture site months after injury
• Ongoing swelling, tenderness, or instability around the limb
• Difficulty weight-bearing or recurrent “giving way”
• A visible change in limb shape or alignment
• Limping, uneven walking, hip or back pain due to compensation
• Reduced range of movement or function
• A limb that looks or feels shorter/longer than the other
• Persistent wound problems, discharge, or recurrent fevers (possible infection)
• Numbness, tingling, weakness, or circulation problems in the limb

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Diagnosis

Limb reconstruction assessment typically involves careful planning and detailed imaging. Your consultant may recommend:

• Full history, including injury/surgery background and current functional limits
• Examination of alignment, joint movement, limb length and gait
• Assessment of skin and soft tissues (including scars and wound healing)
• Imaging such as:
  • X-rays for alignment and bone healing
  • CT scan for complex bone detail or non-union assessment
  • MRI where soft tissue or infection is suspected
  • Ultrasound in selected cases
• Blood tests if infection is suspected
• Review of previous operation notes and imaging where available

You will receive a clear explanation of findings and a proposed pathway, including expected timescales and key milestones.

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Treatment & Management

Treatment is highly individual and depends on the diagnosis, your overall health, and your functional goals.

Non-surgical management (selected cases)

Some patients benefit from a period of non-surgical treatment first, such as:

• Physiotherapy and strengthening programmes
• Bracing or orthotics
• Pain management and activity modification
• Bone health optimisation (e.g., vitamin D, osteoporosis assessment where relevant)

Surgical reconstruction options (when needed)

Surgical planning may involve one or more of the following:

• Fixation revision for non-union (plates, nails, external fixation)
• Bone grafting or bone regeneration techniques
• Deformity correction (osteotomy) with realignment and stabilisation
• Limb lengthening procedures using specialist fixation methods
• Management of infection, including removal of infected tissue and staged reconstruction
• Soft tissue reconstruction coordination where required

Your consultant will discuss benefits, risks, expected recovery, rehabilitation needs, and how surgery may be staged over time for the safest outcome.

Rehabilitation and recovery

Rehabilitation is usually a major part of successful limb reconstruction and may include:

• A structured physiotherapy plan
• Gradual progression of weight-bearing
• Gait retraining and mobility support
• Pain and swelling management
• Occupational therapy support where needed

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When to seek urgent help

Seek urgent medical advice if you experience:

• Increasing pain, redness, heat and swelling with fever (possible infection)
• Sudden inability to weight-bear or new deformity after a fall
• New numbness, weakness, or a cold/pale limb
• Wound breakdown or persistent discharge from a previous surgical site

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If you have ongoing symptoms after a fracture or orthopaedic surgery, concerns about limb alignment, length, healing or infection, contact Royal Buckinghamshire Hospital for assessment and guidance. There is no need to be registered with the hospital, or live locally.

If you have insurance which covers consultations, we can in most cases invoice the insurer directly. Where you are paying directly, any costs will always be discussed.