Restoring function,
rebuilding limbs.

Pin-site care at home.

Pin-site care is the single most important thing you will do at home. Clean your pin sites once a week using chlorhexidine (the pink solution), and change all of the dressings at the same time. The full routine is set out below.

• Once a week — clean the pin sites and change every dressing. Between cleans, the limb is kept completely dry.
• Shower with the frame — you can shower the leg and frame once a week, immediately after cleaning the pins.
• Use chlorhexidine — the pink solution provided by the clinic. Do not use other antiseptics, ointments or creams on the pin sites.
• Leave crusts in place — do not pick or remove the crusts that form around the pins. They are part of normal healing.
• Keep the limb dry — for the rest of the week, the pin sites and frame should be kept completely dry.
• Your specialist nurse will guide you — the routine is demonstrated in person before discharge, and the video below walks through it step by step.

The video below was made by our specialist nurse, Rex Turita, and demonstrates the weekly routine step by step. We recommend watching it before your first independent pin-site care at home, and as often as you find helpful afterwards.

Helping your body to heal.

A few simple things make a real difference to how quickly your bone heals and how long you spend in the frame. These are covered in detail in the booklet, but in brief:

• Stop smoking and vaping — the single most important thing you can do. Smoking roughly doubles the time you spend in the frame, to around nine months on average, and increases the risk of pin-site infection and slow wound healing.
• Avoid alcohol — alcohol reduces calcium absorption and slows bone healing. Try to avoid it completely throughout treatment.
• Avoid anti-inflammatory medicines — drugs like ibuprofen and diclofenac slow bone healing. Paracetamol is fine, and we will prescribe stronger painkillers if needed.
• Eat well — a balanced diet rich in calcium, vitamin C and vitamin D supports healing. Short periods of sunlight in summer help vitamin D naturally.

Recognising a pin-site infection.

Around half of patients in a circular frame will develop a pin-site infection at some point. This is common and usually quickly resolved if we hear about it early. Please do not go to your GP. Instead, send a photograph and a message to our specialist team at Manchester Royal Infirmary, who can review and arrange treatment promptly.

Contact the specialist team if you notice any of the following:

• Increased pain around a pin site.
• Redness, swelling, or warmth at a pin site.
• Oozing — either bleeding, or yellow and cloudy discharge.
• Feeling generally unwell, with a fever.

Follow-up and frame removal.

After surgery, you will be seen in the frame clinic at two weeks, then at six weeks, then every six weeks until the frame comes off. During active turns or adjustments, we see you every one to two weeks to check your progress. Your specialist nurse will give you a direct contact number for any questions or concerns between visits.

Before removal, you will go through a period of dynamization, where parts of the frame are gradually loosened to confirm the bone has fully healed. Once we are satisfied, the frame is taken off in the clinic procedure room using inhaled gas-and-air for pain relief. Almost all frames come off this way. Occasionally, if a patient feels very anxious, we will remove the frame in theatre instead.

A boot or cast may be needed for a short period afterwards while things settle. The pin sites must remain dry until they have healed before you can return to daily showering.

If something doesn’t feel right.

Your treatment is a journey, and there may be bumps along the way. You will be given a direct telephone number for the specialist team while your frame is on, and you can call this number whenever you are worried about something.

If possible, please ring the clinic before attending an accident and emergency department. We can usually advise on the best place to be seen, which is not always the nearest A&E. Earlier contact is almost always better than later, and we would always rather hear from you than have you wait at home, uncertain.