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Latest News 11 December 2015

Direct Skeletal Fixation - Key Facts

Direct Skeletal Fixation (DSF) is an overarching term used by the NHS in England to describe the surgical procedure to implant a titanium rod into the shaft of a bone, from which part is exposed through the skin to which an external prosthetic device can be directly attached.

The Chancellor recently announced £2 million to fund a programme led by a MoD team to provide this surgery to up to 20 serving military or veteran patients over 2 ½ years from April 2016. Previously the MoD had funded 5 serving personnel (3 sent to Australia and 2 surgeries carried out in the UK) and we are aware of 3 veterans that have had the surgery privately in Australia.

Blesma campaigned hard for this and are delighted that this programme will go ahead. The surgery can, for some, be life changing. The surgery dispenses completely with the need for traditional prosthetic sockets, a source of severe complications for some. Due to the nature of the residual limbs of some of our wounded men and women, they have been left either a permanent wheelchair user, unable to walk unaided or in constant pain and enduring repeat visits to their limb centre in an effort to try sockets they can tolerate.

Although potentially life changing for some, this surgical option is not suitable or eligible to every serving or veteran amputee. The full referral pathway is yet to be confirmed but for veterans this will be via your NHS Limb Centre and will be based on Clinical Need. Below is a list of Key Facts, provided by the MoD team leading this programme.


To be eligible for referral to DMRC Headley Court, Veterans must have previously been treated by the Prosthetics service at DMRC AND be in receipt of AFCS or War Pension. All referrals are subject to final Ministry of Defence/NHS approval.

Clinical Criteria

  1. Through or above knee amputee – through knee will require conversion to above knee during implant fitting surgery
  2. Primarily a wheelchair user
  3. Ongoing socket fit issues – Unable to obtain adequate sockets through NHS and/or MoD prosthetic services
  4. Non smoker
  5. No active infections or osteomyelitis
  6. Non-diabetic
  7. Must be able to commit to at least two 6 week periods of rehabilitation at DMRC
  8. Mentally must be able to tolerate protruding metal devices from the residual limb – psychology assessment prior to surgery


  1. Must remain a non-smoker
  2. Must be aware that DSF implants are not considered safe for running, whatever prosthetic devices are used distally.


  1. Surgical risks from orthopaedic operation
  2. Infection - potentially leading to implant removal, further stump revision or bone resection which may further compromise future socket use
  3. Long term cancer risk from stoma requiring annual review as a minimum

If you would like to discuss the above, please contact our Prosthetics Support Officer on 0208 548 7080 or email

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