A long, painful journey from Siberia

Kate Bullock's brother came close to losing a leg, until a new treatment arrived from the East in a tangle of wires. She traces his recovery

One dark February morning 25 years ago my brother Richard and I set out on our paper rounds and within minutes he was hit by a car which lifted him off his bike, onto the bonnet, and through the windscreen. By the time my mother arrived he was conscious, and apologising for giving her yet another fright. At the age of 15 his tendency to injure himself was legendary, but this was by far the worst incident.

At the hospital his shattered left leg was pinned and plastered. He was in traction for months and, after some gruelling physio, left the hospital with a pronounced swagger as a result of the now shorter, misshapen left leg. This caused my father to comment that he was glad to have two good legs (his little joke as he lost his right leg in France in 1944).

Richard's leg caused him intermittent pain but during the next few years he was usually distracted by other smaller accidents involving panes of glass, ladders and knives; he once managed to dislocate his shoulder while lifting himself into an attic space. I was in hospital at the time having my appendix removed, and my mother was in the waiting room when Richard was wheeled past.

Eventually, when he was 40, the pain in Richard's leg became so bad that he was referred to St Peter's Hospital, Chertsey, where it was discovered that he had osteomyelitis, an infection of the fibula, a bone of the lower leg, as a result of the accident.Antibiotics are generally ineffective for this condition and the orthopaedic surgeon, Rowen Pool, proposed surgery to remove the infected part of the bone.

Richard had three inches of infected bone sawn out of his leg, which was then broken lower down. A special metal structure, called an Ilizarov frame, was then fitted to allow the bone to grow and repair itself at the site of the break.

The frame is named after Gavril Ilizarov, a Siberian surgeon who developed it from bicycle spokes with the help of local blacksmiths in 1951. He was determined to offer something more than amputation to soldiers injured after World War II and the frame helped them to grow new bone. For Richard, the frame provided the only chance of saving his leg.

The amazing thing about the frame are the four-inch metal pins which had to be pushed right through Richard's leg and twisted by one millimetre every day to pull the bone up and make space for new growth. The pain is excruciating and Richard has been on strong painkillers ever since having the frame fitted.

Seventeen months later the frame is still there. Richard's three-year- old twin daughters cannot remember him without it. At one stage he had 15 bits of wire going right through the bone, and the whole thing looked quite remarkable, and fascinating in a repulsive sort of way. At a party, people gathered around, unable to believe that the pins on the frame really entered his leg.

In November 1995, Mr Pool judged that the bone had grown as much as it needed to and the frame's supporting "struts" were loosened off. The bone now has the strength of chewing-gum and the muscle is completely wasted. Richard has to put weight on his leg as often as possible, to strengthen bone and muscle. He hobbles around the house without crutches and is counting the days to when it can be removed entirely.

Wearing the frame has at times been agonising. Richard was almost constantly on antibiotics because of infections at the pin sites. He was also found to be allergic to morphine - which could have helped with the pain - and the muscles in his foot atrophied through lack of use. Counselling was offered before surgery because of the acknowledged difficulty of the procedure.

But Richard would not hesitate to go through it again and is grateful that he has had this opportunity to save his leg.

It is now thought that Henry VIII had osteomyelitis which might account for his being so frightfully grouchy. Richard's remarkably sunny nature has held up well during the ordeal, and his wife retains her head.

A 'QED' programme on the Ilizarov frame will be broadcast on BBC1 on Thursday at 10pm. 'Baby in a frame' follows the progress of six-month old William Knight, the youngest person to have an Ilizarov frame fitted to correct club foot.