The BLRS, sought a consensus view from limb reconstruction healthcare practitioners across the United Kingdom to help guide research priorities within Limb reconstruction surgery. This project was led by Simon Graham. The aim was to guide future clinical research in limb reconstruction surgery, and to assist healthcare practitioners, clinical academics, and funding bodies in identifying key research priorities to improve patient care.

Top 11 research priorities identified in adult Limb reconstruction surgery:

1. What are the most appropriate functional- and PROMs in both trauma and elective limb reconstruction surgery and how is this information best collated?
2. Is the use of specialist LRS physiotherapists more clinically and cost-effective than non-specialist therapy in the management of patients with a circular frame?
3. Does the incorporation of psychological support pre- and post-operatively improve patient and functional outcomes in the management of complex trauma and limb reconstruction surgery?
4. What are the long-term implications (risk of osteoarthritis) of lower limb joint (ankle and knee) mal-alignment and/or shortening following a fracture?
5. What is the clinical and cost-effectiveness of single vs two-stage surgery in the management of bone infection/ osteomyelitis?
6. Is the use of circular frame fixation more clinically and cost-effective than internal fixation in the management of open tibial fractures?
7. When removing an external fixator, is the use of local sedation methods (entonox/penthrox) of anaesthetic in a non-theatre setting (clinic) more clinically and cost-effective than removal under general anaesthetic?
8. What is the clinical and cost-effectiveness of high-dose vitamin D vs no supplementation for the management of non-unions and lengthening?
9. What is the risk of infection in the treatment of a fracture with internal fixation following the application of a temporary external fixation?
10. What is the clinical and cost-effectiveness of circular frame vs internal fixation methods for the treatment of complex tibial plateau fractures?
11. What is the clinical and cost effectiveness of single vs two stage surgery in the management of infected fracture non-unions?

Top 10 research priorities identified in paediatric Limb reconstruction surgery:

1. What are the most appropriate functional- and PROMs in both paediatric trauma and elective limb?
2. Does the incorporation of psychological support pre- and post-operatively improve patient and functional outcomes in the management of complex paediatric trauma and limb reconstruction surgery?
3. In children aged 10 years or over with limb length discrepancy of the tibia and/or femur, are internal lengthening techniques (IM nails and/or plates) more clinically and cost-effective than external fixators methods (circular frame or rail)?
4. In children with congenital pseudarthrosis of the tibia, is adjunctive use of bone morphogenic proteins and/ or bisphosphonate more clinically and cost-effective when compared with standard care (no adjunctive treatment)?
5. In children, younger than 10 years old, with limb lengthening discrepancy of the femur, are internal lengthening techniques (IM nails and/or plates) more clinically and cost-effective than external fixators methods (circular frame or rail)?
6. In children with limb length discrepancies, is early surgical equalisation more clinically and cost-effective than allowing children to reach skeletal maturity with untreated/residual limb length discrepancy prior to considering lengthening?
7. What is the best pain management regimen in the management of children undergoing limb reconstruction surgery?
8. In children with significant longitudinal deficiency, is reconstructive amputation and prosthetic fitting more clinically and cost-effective than management with no surgery and prosthetic fitting?
9. What are the effects on the articular cartilage and/or growth plate following limb lengthening surgery to the femur/tibia for congenital limb deficiency?
10. In the population of children with asymptomatic genu valgum, is treatment of deformity with 8-plate hemiepiphysiodesis more clinically and cost-effective than non-operative management?

British Limb Reconstruction Society Research Collaborative. Identifying Research Priorities in Limb Reconstruction Surgery in the United Kingdom. Strategies Trauma Limb Reconstr 2024;19(1):1–8.