by Kellicker PG
(ORIF)

Definition

An open reduction and internal fixation (ORIF) puts pieces of a broken bone into place using surgery. Screws, plates, sutures, or rods are used to hold the broken bone together.

Reasons for Procedure

An ORIF is often done as an emergency procedure when a broken bone is in many pieces. It is done to allow the bones to heal together.

Possible Complications

Problems are rare, but no procedure is free of risk. Some things that may happen are:

  • Reaction to anesthesia
  • Bleeding
  • Infection
  • Nerve damage
  • Fat particles or blood clots that move to the lungs
  • The need for later surgery if the bone does not heal well

Talk to your doctor about things that may raise your risk of problems, such as:

  • Smoking
  • Drinking alcohol
  • Chronic health problems, such as diabetes or obesity
  • The use of certain medicines

What to Expect

Prior to Procedure

This is often as an emergency procedure. Before your surgery:

  • Tell your doctor what you last ate and drank.
  • Tell the doctor about the medicines and supplements you take.

Instructions will be given if the surgery is planned. Before surgery:

  • Arrange for a ride to and from the procedure.
  • Arrange for help at home.
  • Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
  • Eat a light meal the night before. Do not eat or drink anything after midnight.

Anesthesia

General anesthesia will be used. You will be asleep. Some people may need a spinal block. This will numb the area where surgery will be done.

Description of Procedure

An incision will be made in the skin above the break. The pieces of bone will be moved into the right place. A plate with screws, a pin, or a rod that goes through the bone will be attached to the bone to hold the broken parts together. The incision will be closed with staples or stitches and covered with bandages. The area will be protected with a splint or cast.

Open Reduction and Internal Fixation Surgery of the Ankle
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Immediately After Procedure

An x-ray will be done to make sure the bone is in the right place.

How Long Will It Take?

An ORIF surgery can take several hours. It depends on the type and location of the broken bone.

How Much Will It Hurt?

Anesthesia will prevent pain during the procedure. Pain after the procedure can be managed with medicine.

Average Hospital Stay

Most people are able to go home the next day. People who have problems may need to stay up to a week.

Post-procedure Care

At the Hospital
  • You will be asked to get out of bed and walk 2 to 3 times a day to help with blood flow.
  • You will be taught how to do exercises that help with strength and range of motion.
  • You be taught how to use devices, such as a a wheelchair or crutches .

During your stay, staff will take steps to lower your risk of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to lower your risk of infection, such as:

  • Washing your hands often and reminding others to do the same
  • Reminding staff to wear gloves or masks
  • Not letting other people touch your incisions
At Home

It can take three to six weeks for a mild fracture to heal. It may take many months for a severe fracture of a long bone to heal. Exercises to help with muscle strength and range of motion will be needed.

Call Your Doctor

Call the doctor if you are not getting better or you have:

  • Pain that does not get better with medicine
  • Redness, swelling, more pain, a lot of bleeding, or discharge from the incision site
  • Signs of infection, such as fever and chills
  • Numbness or tingling at the injury site
  • Problems moving the fingers or toes of an injured arm or leg
  • A cast that feels too tight
  • Burning or stinging under a cast
  • Red skin around a cast
  • Itching under a cast that does not go away
  • Cracks or soft spots in a cast
  • Chalky white, blue, or black skin color in the fingers, toes, arm, or leg

If you think you have an emergency, call for medical help right away.

RESOURCES

American Academy of Physical Medicine and Rehabilitation  http://www.aapmr.org 

National Institute of Arthritis and Musculoskeletal and Skin Diseases  http://www.niams.nih.gov 

CANADIAN RESOURCES

The Arthritis Society  http://www.arthritis.ca 

Canadian Orthopaedic Association  http://www.coa-aco.org 

References

Femoral shaft fracture—emergency management. EBSCO DynaMed website. Available at:  https://www.dynamed.com/management/femoral-shaft-fracture-emergency-management  . Accessed September 24, 2019.

Fractures: an overview. Ortho Info—American Academy of Orthopaedic Surgeons website. Available: http://orthoinfo.aaos.org/topic.cfm?topic=A00139. Updated October 2012. Accessed September 25, 2019.

Setting broken bones. Cedars-Sinai website. Available at: http://www.cedars-sinai.edu/Patients/Programs-and-Services/Orthopaedic-Center/Treatment/Setting-Broken-Bones.aspx. Accessed September 25, 2019.

Welck MJ, Hayes T, et al. Stress fractures of the foot and ankle. Injury 2017 Aug;48(8):1722.

Revision Information