After years of helping patients with rehabilitation after injuries in her role as a physiotherapist, Lena found herself in the same position. She explains, “No one ever expects to have a serious accident, so when it happens it’s quite a shock.” 

As an experienced horse rider, Lena had been out with a friend enjoying a ride together on their horses, when her friend’s horse kicked out while cantering. Lena was struck on her leg and catapulted from the saddle in a bad fall.  She immediately knew she had a serious fracture and was initially taken to her local hospital.  Due to the severity of her injury, a shattered tibia, she was sent to King’s College Hospital for treatment. 

At King’s there was no option but to fit a Taylor Spatial Frame to help realign the multiple fractures of her tibia. The frame consisted of a number of pins and wires which were driven into the bone and attached to external metal rings.  These could be adjusted to realign the bone as it healed. The frame was fitted on December 31st and the following few weeks were taken with adjusting the struts of the frame to reposition and lengthen the fractured bone.  Lena’s husband was able to do the daily adjustment of the struts, which helped considerably.  Lena also needed to follow a rigorous cleaning and wound dressing regime to help prevent infection. 

On a normal day, Lena has a very active life.  She runs a busy livery yard, taking care of 14 horses, while working as a riding instructor and also providing occasional equine physiotherapy.  After the accident, she initially found it extremely hard to be still and rest.  Her broken leg and the frame itself meant that she had a physical barrier to work, and Lena found this very frustrating at first, but she was able to get extra support to help her continue running the yard.  It wasn’t long before she found a solution, working at a slower pace but still making a contribution.  Being in a muddy farmyard environment presented a challenge when wearing her frame.  Lena had to adapt by wrapping the frame in waterproof ski-suit fabric and she managed to find some baggy zipped trousers that she could pull over the frame to keep warm during the cold months of the winter.  

Lena had trained at King’s for her physiotherapy career so knew the hospital well. While working as a physiotherapist, she had specialised in neurological conditions and patients with brain injuries, often treating patients with PTSD.  This had given her a deep understanding of mental coping strategies, which she believes helped her enormously with her own injuries.  Working on the positive aspects of her situation was a key coping mechanism in this.  Lena explains that she would always challenge herself to turn negatives into positives, whatever the situation. 

After the initial shock and realisation that she couldn’t continue as normal and would have to slow down and adapt, she set about thinking of positive things that she could do in her situation.  Top of the list for her was catching up with people that she hadn’t seen for years.  This was something that she had been wanting to do but never had the time, and she found it really enjoyable and a distraction from her leg.  She would take time to plan their visit, even preparing meals and at a very slow pace, would keep up with housework.  Lena also found she had the time to read books and other things that she wouldn’t normally have time for.  

Lena was able to bare weight on her leg very soon after the accident and focused on her exercises.  She believes these were vital in her recovery and explains that her injured leg is now the stronger of the two.  She feels that her positive attitude towards recovery was also beneficial for her family and helped ease their worries, particularly when she faced the challenge of infections.  Despite having a careful cleaning routine, she unfortunately had a number of infections around the pin site and had to be treated with antibiotics.  By May, Lena had a bad infection which continued, despite antibiotics, and it was discovered that the pins of the frame were effectively coming out of her leg causing her to walk on the bone.  At this stage the frame was removed.  Because of the location of the fracture, she was unable to use a boot, so had to rely on crutches instead.   

      

For Lena, being able to ride again was a big milestone in her recovery and once her leg was strong enough, she began working towards riding.  She was conscious that her biomechanics may have been affected by the injury, so first booked sessions on a mechanical horse to work on this and check her balance.  Once she was confident she moved onto a horse and since this huge achievement has continued to enjoy riding again. 

Lena’s advice for anyone who finds themselves with a similar injury is simple, “Don’t panic!  Stay positive by doing exercises – anyone can do them.  Think about doing things that you don’t usually have time for and try to turn the negative into positive, no matter how small.”

 

Jamie is a long term limb reconstruction patient at King’s Hospital. He shares his personal experience of life during treatment and inspiring words of advice in a Q&A.

 

Introduction

My name is Jamie, I am 30 years old and I work in the TV Industry as a Production Coordinator.

I enjoy travelling, going for brunches, seeing friends and family, playing chess. I enjoy walking in nature, swimming, cycling and the odd game of golf in the summer.

What brought you to King’s Limb Reconstruction Team? 

I was introduced to the King’s Limb Reconstruction team when I was a child at approximately 3 years old. I was born with a congenital condition called Hereditary Multiple Osteochondromas, which affects bone growth and development, causing bony growths called exostoses. I have been under the care of King’s ever since. I have had multiple surgeries and am still able to count how many I have had with my fingers and toes! I feel lucky to still be able to do that.

What treatment did you require and what was the duration?

I have required multiple surgeries throughout my life. I have had operations on my fingers, arms, shoulders, back, pelvis and numerous surgeries on both of my legs. These surgeries were required to remove bony growths, which caused me pain and discomfort, alongside restricted motion of my joints.

In the last 5 years, I have had several surgeries due to valgus deformity in both my legs and limb-length discrepancy, because of this I have had surgeries that cut and reshaped my bones to change the alignment and correct the deformity.

I have had 19 surgeries throughout my life, with the vast majority being when I was a child. I have several plates in both my legs and have had one Taylor Spatial Frame.

How did you feel during your treatment?

During each treatment and throughout each rehabilitation, I felt incredibly supported by the King’s Limb Reconstruction team. They made me feel at ease, strong and never alone. I have a very good rapport with the team that looks after me, built on respect, honesty, and trust. I owe them my life and without them, I wouldn’t be where I am today, they’re a family to me.

During my treatment, I am sure I am not the only one who has struggled with anxiety and depression. I believe mine was caused by several reasons, mostly due to stress related to the recovery; speed of recovery, the return home practicalities, financial costs, return to work, etc, and none more so, than feelings of guilt about depending on others. As someone who is very independent, it’s difficult to take.

The Limb Reconstruction team really helped me throughout, physically as well as mentally, they always communicated with me and were very responsive, which must have been hard given how incredibly busy they are. They also made me feel like I was not alone and that we were in it together, which meant everything to me.

What were the day-to-day issues and how did you manage them?

My day-to-day issues were daily tasks including, but not limited to; showering, cooking, getting dressed, cleaning, and general tasks we often take for granted.

One of my main issues is the mental stress of recovering from a surgery, such as anxiety and self-doubt, alongside experiencing and managing the pain. I am someone who doesn’t do well with sitting still, I like to push myself and I like to have long-term aims and set goals. With every surgery, comes a hurdle, a physical and mental hurdle which comes before me, often unexpectedly.

Although I have had several surgeries, each surgery is different and the process of the recovery is different. I am still learning how to manage the physical and mental implications, I’ll be forever learning. But I do know one thing, I had to do my best to be kind to myself, trust the process, believe in myself, believe in others and be as positive as I can always be, because no matter what has happened to me, or will happen to me, it can always be worse.

During my surgeries, I reflected on my recent and past achievements, and I worked towards getting back to that moment, that moment of happiness.

In the months leading up to a recent major surgery, I had prepared and been on shoots in the Lake District (where I completed my first ever hike), inside Burnley Football Club stadium (empty and full), amongst thousands of Burnley Fans as they did their title parade through the city and finally a shoot in Croatia with the most wonderful team.

I got through the only way I know how, by giving everything I have and playing my part to the best of my ability which helped me in the lead up to my surgery.

How did this affect your work and life in general?

The affect the surgeries have had on my work and life is massive, especially since being an adult. When I was a child, the two main problems I had were that I often needed to reschedule my exams and I was bullied a lot. I always had support from my family. Since becoming an adult, these problems do not exist anymore, but many other problems do.

Throughout my recent surgeries, my work and life were affected. There were big financial stresses, having to pay bills with the rise in cost of living and for the majority of the time, only having statutory sick pay. All this, alongside trying to recover from a major surgery can be hard. Having difficult conversations with work which was caused mainly by my own insecurities; scared if they will want me back, scared that they may no longer need me, scared that I had let them down.

Regarding my life in general, I struggled with accepting help from others without feeling like a burden, I often struggled going out in public places, I struggled sitting still and trusting the process of recovery.

I struggled with members of my family, they were not as supportive or did not express their support to me, this may be because they think I am used to having surgeries and I didn’t need the support, but I did, I just struggled to accept it or ask for it.

Do you think your condition or treatment had an impact on your family?

I believe my condition and treatment only had an impact on certain members of my family. My father has the condition, he had one surgery when he was younger. I know he feels guilty about giving me the condition. I do not blame him, and I never will, but I believe this affects him and as a result, he struggles to support me because of it.

I have a huge family, but no one understands the affect it has on me or how difficult the recoveries can be or the work and personal struggles, but they wouldn’t, as they haven’t experienced it or anything similar.

My grandparents are supportive, but again, I am quite reserved and independent. Perhaps this is part of the reason why I feel it has not impacted my family as much as it may have if I opened up on the struggles more and did not feel like a burden.

How has Rebuild supported you?

Rebuid has been absolutely invaluable, supporting me from recovery to rehabilitation. Since its creation, they have funded the appointment of a specialist Physiotherapist and provided additional specialist Nursing, both of which, I am lucky to have felt the enormous benefit of. The website is very informative and easy to navigate, it has brilliant advice for someone going through limb reconstruction treatment and also their families or friends, as it affects everyone in some way.

I am also aware of the Citizens Advice Service for patients which can be used for financial and work concerns.  I haven’t personally used this service but I wouldn’t hesitate if I felt I needed it. I encourage patients to maximise the services available, it can be life changing and you deserve it, they love to help and you’ll always feel supported.

What words of advice would you give someone starting out treatment?

The main advice I can give someone is to be kind to yourself, you’re amazing. Mental fortitude is everything and it will determine how you handle adversity, there is light on the other side, however long it takes, days, weeks, months, years, there is light and it’s waiting for you.

Physio is incredibly important, keep on top of it, make it a priority, invest it in, celebrate each win, each bit of progress.

Surround yourself by the people who make you feel better and make you smile. Focus on the rebuild, start small and focus on the little wins, step by step. Accept help, don’t feel guilty, you deserve it, we all do.

 

Robert’s Story
I was granted ‘membership’ of the KCH Limb Reconstruction Club in 2009. I arrived at King’s as a military patient, having been transferred from Selly Oak Hospital, Birmingham. I had been injured whilst serving on operations the year before. Unfortunately, the vehicle that my team and I were in hit an improvised explosive device (IED) which destroyed the vehicle and left three of us badly injured. Having received emergency medical treatment on the ground and been extracted back to one of the main NATO bases, we were all flown to the UK for further treatment. It was the end of our tour.

It’s an odd thing, coming round a number of days later, not realising where you are or what’s happened to you, with nurses asking you if you are aware of your own current whereabouts. Those seriously injured were moved to Selly Oak and, although a NHS hospital, certain wards housed injured military personnel. During that period, the number of soldiers treated at the hospital was significant.

Those who have been injured in IED incidents typically have complex breaks which aren’t always easy to fix. Many are irreparable, hence the high number of amputees. Time spent at Selly Oak varies, depending on the nature and severity of the injuries. Some soldiers move quickly from Selly Oak to Headly Court (the military’s rehabilitation facility), others are there for longer. Ultimately, almost all end up at Headly Court for a period of rehabilitation. Unfortunately, some soldiers’ injuries are so severe they are medically discharged from the Army. Sadly for some, although they made it home, they succumbed to their injuries in hospital surrounded by heart-broken family.

I was under the care of Selly Oak for almost a year and a half, during which time I had numerous operations to try and fix the damage to my legs. Unfortunately, they never quite managed to fix my left leg, and a decision was made to move my treatment to King’s Limb Reconstruction Unit and, specifically, under the care of Mr Graham Groom. It was quickly determined that, in order for my leg to have a chance to heal, the previously inserted metal rod in my leg would need to be removed and a Taylor Spatial Stack Frame applied. Subsequently, after 18 months of treatment, a frame was applied and remained on my left leg for nine months.

During the preceding 18 months there had been a few peaks and troughs. The rest of my injuries had healed well, and my body had regained strength. I was also taking less pain medication, which resulted in me feeling better and more normal. However, my left leg was not playing the game due to the complexity of the injury and the fact that it had been left infected for such a long time. Frustrations can set in, compounded often by pain, the effects of the medication one takes and, for many, the physical restrictions injuries and treatments place on your life. These ‘down’ periods can be cyclical in nature or can remain for protracted periods. Either way, it is not just the patient who suffers frustration but also his family. It is at these times when speaking to others, sharing those frustrations and, for some, going to church can make a real difference. For me and my wife, it was our church and faith that provided us needed support.

Whether it was due to having an occupation that required a high level of physical fitness, genetics, the amazing skill and dedication of Mr Groom and his team or faith – or a combination of all these factors – my leg healed quickly with the frame on. Soon after the frame was taken off, I began a rehabilitation programme at Headly Court and I was signed off fully medically fit again.
The staff at King’s Orthopaedics Department, and particularly those within the Limb Reconstruction Unit, are an amazing group of people, utterly dedicated to their patients, restoring people’s lives and the continuation of the service they are devoted to. I truly feel blessed to have come under their care, not just because I can run again, but because of the care and friendship they extended to my wife and me during that period of our lives.

Adrian’s Story
On 9 February, 2003, while in France, I broke my right leg in a snowboarding accident. It was a spiral fracture. I broke the right fibula and tibia. At the time it didn’t seem too serious as far as broken legs go.
I had an operation in France to have a plate put in the leg, then was treated in my local hospital. After about seven months the plate snapped. When they operated to replace the broken plate, serious problems started, with infection plus non-union. I was transferred to King’s College Hospital and have been undergoing treatment there ever since. I had three frames put on between 2005 and 2009, first an Ilizarov, then two Taylor Spatial frames.
To keep busy and stay in shape while enjoying the fine weather, I started weight training with a bench and a couple of dumbbells in the garden. I used to put my leg up and just did whatever I could. I would work around my injury and do things at my own pace. I also tried swimming , but this was the one sport I could never really get the hang of, even before the accident. It was only while in the Taylor Spatial frames that I really started to make progress. It was hard work with all that metal but, over two years, I went from struggling to do five lengths to doing 100.
I was a bricklayer and, at the time of the accident, had a good job working for a small retail maintenance firm.
Six months after the accident, when things weren’t going to plan, I started to think what else I could train as, just in case my leg didn’t heal. I used the time to go to free adult education classes. I did maths and English courses for the first year, then paid for various bookkeeping, accounting and ECDL (European Computer Driving License) computer courses.
While in my second frame and doing an NVQ accounting course, I won a career development award, but was not able to go to the ceremony as I was in hospital having an operation.
Starting something new
My final frame came off in February 2009 after more than six years of treatment. If it weren’t for the encouragement and care I received at King’s College Hospital, I would not be in the position I am now.
Within four months of the frame being taken off, I competed in my first ever triathlon, a novice event in which I came seventh out of about 50. I received an Outstanding Achievement Award from Ashford Tri Club head coach Christine Johnson. So a big thank you from me to everyone who has looked after me over the years. I have continued with the triathlon and joined my local club, Ashford Tri. They have encouraged me, made me feel very welcome and part of the group.
I would like to say a big thank you to Marjorie and Mark, my mum, dad and brother Philip, who have always been there for me through some quite tough times.
Back in a frame
Due to an accident on the 13 August, 2009, my leg has refractured. I was cycling to a hospital appointment when the chain came off the bike. The leg was a mess with a big compound fracture.
I had an operation at Ashford’s William Harvey Hospital where they just washed out the wound and the leg was put in a back slab. I had already requested, and was transferred to King’s the following day, where my fourth frame was put on, on 15 August, one day before a planned triathlon in Worthing.
I had only been back at work full time for eight weeks of a three month trial, and lost that job. But they were good to me, and paid me full pay up to the end of September, for which they had no obligation. This has given me breathing space and time to fill out all those lovely forms.
I have started swimming again. It is still hard, slow work even after so many years of swimming with the frames, and I still get a great sense of achievement from every little goal I achieve.
I think for me the key is to achieve small weekly goals, then the long-term goals will follow.
I am back to doing physio sessions two to three times a day. They are the key to success if you want to go back to an active life once the frames are removed. I completed two triathlons, did lots of long runs, some cross-country over the South Downs and some distance bike rides, and think this is due to keeping active while in the frames.
I do know I will be back, fighting fit.

Tony’s story
My introduction to the Limb Reconstruction Unit came as a result of a medical accident. Over a period of two or three years I had had continual knee problems, largely as a result of sports injuries. In 1999, at the age of 47, it was suggested that I should have an upper tibial osteotomy operation. The cartilage in my left knee was breaking up and the operation would straighten the leg and remove the pressure, I would be able to play tennis again and continue to cycle.
In November that year, an orthopaedic surgeon in Kent preformed the operation. It require a cut to the tibia and fibula, but rather more happened. The tibia and fibula were cut right through and the deep peroneal nerve was severed. I left hospital with a leg that could swing from left to right, and a drop foot.
After several months of painful physiotherapy my physiotherapist insisted I got a second opinion. This is when I discovered to my horror that I had a very unstable disunited fracture of the tibia and fibula. If the limb could not be reconstructed I would need amputation. I was referred to Mr Graeme Groom at King’s College Hospital.
An Ilizarov frame was put on to my leg. After four months it was removed, the tibia and fibula had reunited and I had recovered some nerve sensation, which restored dorsiflexion to my foot. Some follow-on complications were resolved and two years after I entered hospital for the initial botched operation, I was able to return to work.
Although I can no longer play sport, mainly because of the peroneal nerve, not to mention advancing years and girth, I have been able to resume swimming and cycling.
The unit is doing fine work and I am proud to be a Founder Trustee and Deputy Chair of this charity.