Precision frames, rebuilt limbs.
Circular frame surgery — Ilizarov and computer-assisted hexapod fixation — for complex fractures, non-union, bone infection, deformity and limb lengthening. Mr Nesbitt runs one of the highest-volume circular frame practices in the UK.
What is a circular frame?
A circular frame is an external fixator — rings positioned around the limb and connected to the bone, used to hold, move or gradually reshape it from outside the skin while it heals.
Rings are connected to the bone above and below the area of injury or deformity using fine wires or half-pins, and linked to each other by rods, struts or hinges. Because the frame sits outside the limb, it allows the bone to be held rigidly, gradually compressed, distracted or repositioned — all while the patient remains mobile and the soft tissues are left undisturbed.
The Ilizarov frame, developed from the original ring fixator design, uses fine wires and threaded rods adjusted manually according to a pre-planned schedule. The hexapod frame is a modern evolution — six struts connecting two rings, adjusted according to a computer-generated programme that can correct length, angulation, rotation and translation simultaneously.
Both systems are used across the breadth of Mr Nesbitt’s practice — from the acute management of open fractures, through staged reconstruction of infected non-unions, to planned deformity correction and limb lengthening.
When a frame is the right tool.
Circular frames are used across a wide range of trauma, infection, deformity and reconstruction problems — often where internal fixation alone is not appropriate.
Complex & Open Fractures
High-energy fractures with significant soft-tissue injury or bone loss, where a frame allows fixation without further disturbing the wound.
Non-union & Mal-union
Fractures that have failed to heal, or have healed in a poor position, corrected using gradual compression, distraction or realignment.
Bone Infection & Osteomyelitis
Staged treatment of infected bone and infected non-union, often combining infected bone removal with frame-based reconstruction.
Limb Length Discrepancy
Gradual lengthening of the femur or tibia for congenital or acquired discrepancy.
Limb lengthening →Deformity Correction
Correction of angular, rotational and translational deformity of the femur or tibia, often using computer-assisted hexapod frames.
Limb Salvage & TTT
Frame-based bone transport used to regenerate blood supply in limbs threatened by severe vascular disease and recalcitrant diabetic ulceration.
TTT service →Ilizarov vs hexapod.
Both are circular frames in the broadest sense, but they work — and feel for the patient — quite differently.
The Ilizarov frame.
The original ring fixator system, using fine tensioned wires and threaded rods. Adjustments are made manually, following a pre-planned schedule, and the frame can be reconfigured during treatment — making it especially versatile for complex bone infection and staged reconstruction.
Well suited to cases where the construct may need to change as treatment progresses, or where fine wire fixation is preferable for the bone involved.
The hexapod frame.
A modern computer-assisted frame using six struts between two rings. A deformity is measured and entered into planning software, which generates a daily adjustment schedule for the patient to follow at home — correcting length, angulation, rotation and translation together.
Particularly well suited to planned deformity correction and limb lengthening, where accuracy and a predictable schedule are priorities.
A high-volume frame practice.
Mr Nesbitt’s circular frame practice draws on higher surgical training in the North West, fellowship at the Leeds Limb Reconstruction Unit, and dedicated experience in Tygerberg, South Africa.
Living with a frame.
Wearing a circular frame is unfamiliar to most patients, but with a settled routine most people adapt quickly and continue much of their day-to-day life.
On average, a frame is on for about four and a half months from fitting to removal, though this varies with the injury, general health, and how well the bone heals. Good pin-site hygiene is the single most important thing patients do at home, and a specialist nurse demonstrates the full routine before discharge.
- Pin-site care — once-weekly cleaning with chlorhexidine and dressing changes, demonstrated by the specialist nursing team.
- Mobility — most patients remain mobile throughout, with weight-bearing status set individually.
- Follow-up — regular frame clinic review, typically every one to six weeks depending on the stage of treatment.
- Removal — almost all frames are removed in the clinic procedure room using gas-and-air.
The full treatment guide.
A surgeon-authored 16-page booklet covering the full treatment journey — types of frame, preparing for surgery, pin-site care, common problems, follow-up, frame removal and daily life with a frame.
Download the booklet ↓Read the full guide →
Frequently asked questions.
Common questions from patients about circular frame surgery, including practical questions about daily life with a frame.
What’s the difference between an Ilizarov frame and a hexapod frame?
How long will I have to wear a frame?
Can I drive, work or shower with a frame?
Is frame surgery painful?
What are the risks of circular frame surgery?
How do I look after my frame at home?
What happens when the frame comes off?
Make an enquiry.
For private assessment of circular frame surgery at The Alexandra Hospital, book online or enquire below.
Patients, GPs & Consultants
Private assessment for circular frame surgery is available at The Alexandra Hospital, Cheadle. You may self-refer or be referred by your GP or consultant. Please include relevant imaging and a summary of the problem with your enquiry.
- HospitalThe Alexandra, Cheadle
- SecretaryOlivia Clowes
- Enquiriespnesbitt@themanchesterframesurgeon.com
Patients & Families
Private consultations are available at The Alexandra Hospital, Cheadle. Patients may self-refer or be referred by their GP or consultant, and the practice is recognised by major UK insurers.
- Secretarypnesbitt@themanchesterframesurgeon.com
- PrivateThe Alexandra Hospital, Cheadle