Open Reduction and Internal Fixation Surgery
En Español (Spanish Version)

Definition
An open reduction and internal fixation (ORIF) is a type of surgery used to fix broken bones. This is a two-part surgery. First, the broken bone is reduced or put back into place. Next, an internal fixation device is placed on the bone; this can be screws, plates, rods, or pins used to hold the broken bone together.

Reasons for Procedure
This surgery is done to repair fractures that would not heal correctly with casting or splinting alone.

Possible Complications
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Infection
  • Bleeding
  • Reaction to anesthesia
  • Blood clots
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

  • Smoking
  • Drinking
  • Chronic disease such as diabetes or obesity
Your risk of complications may be increased if you have a history of blood clots.

What to Expect
Prior to Procedure
  • Since broken bones are usually caused by trauma or an accident, an ORIF surgery is typically an emergency procedure. Before your surgery, you may have:
    • Physical exam—to check your blood circulation and nerves affected by the broken bone
    • X-ray, CT scan, or MRI scan—imaging tests that take pictures of your broken bone and surrounding areas
    • Blood tests
    • Tetanus shot—depending on the type of fracture and if your immunization is not current
    • Questions your doctor may ask include: How did you break your bone? How much pain do you feel? Do you take any blood-thinning medication?
    • Questions you should ask include: Will I need rehabilitation after surgery? What will I need to assist in my recovery, such as a wheelchair or crutches?
  • An anesthesiologist will talk to you about anesthesia for your surgery.
  • If your surgery is urgent, you may not have time to fast beforehand; make sure to tell your doctor and the anesthesiologist when you last ate and drank.
  • If your surgery is scheduled, you may be asked to stop taking medications, such as aspirin, blood thinners, or antiplatelets.
Anesthesia
General anesthesia may be used. It will block any pain and keep you asleep during the surgery. It is given through an IV (needle in your vein) in your hand or arm. In some instances, a spinal anesthetic, or more rarely a local block, may be used to numb only the area where the surgery will be done. This will depend on where the fracture is located and the time it will take to perform the procedure.

Description of Procedure
Each ORIF surgery differs based on the location and type of fracture. In general, a breathing tube may be placed to help you breathe while you are asleep. Then, the surgeon will wash your skin with an antiseptic and make an incision. Next, the broken bone will be put back into place. Next, 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. A dressing and/or cast will then be applied.

Open Reduction and Internal Fixation Surgery of the Ankle

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Immediately After Procedure
After your surgery, you will be taken to the recovery room for observation. If all is well, your breathing tube will likely be removed while you are there. Your heart rate, respirations, blood pressure, and temperature will be checked often. Your pulse and the nerves close to the broken bone will also be checked.

How Long Will It Take?
An ORIF surgery can take several hours depending on the fracture and the bone involved.

How Much Will It Hurt?
Anesthesia prevents pain during surgery. Pain and discomfort after the surgery can be managed with medications.

Average Hospital Stay
This procedure is done in a hospital setting. Your length of stay will depend on your surgery. You may be in the hospital for 1-7 days.

Post-procedure Care
At the Hospital
  • After surgery, you will be given nutrition through an IV until you are able to eat and drink.
  • You will be asked to get out of bed and walk 2-3 times a day to prevent complications.
  • You will begin physical therapy to learn how to move. You will also be shown exercises to regain muscle strength and range of motion.
  • You will be asked to cough and breathe deeply to prevent pneumonia and atelectasis.
  • Your affected limb will be elevated above your heart to decrease swelling.
During your stay, the hospital staff will take steps to reduce your chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chances of infection such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions
At Home
Before you leave the hospital, you will need to arrange for a ride home. Arrange to get help at home from friends and family until you can manage on your own.

When you return home, do the following to help ensure a smooth recovery:

  • Change your dressing daily or as instructed by your doctor. If the dressing becomes wet or dirty, change it.
  • Once your dressing is removed, keep your incision dry and clean:
    • Cleanse the incision site with lukewarm water and mild soap.
    • Use a soft washcloth to gently wipe the incision area.
    • Your doctor may recommend using an antibiotic ointment before applying a new dressing.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Check your affected limb often for sense of feeling.
  • Get up and walk several times a day.
  • Continue to do exercises prescribed by your physical therapist. Go to all physical therapy appointments.
  • Be sure to follow your doctor’s instructions.
Call Your Doctor
After you leave the hospital, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain in the affected limb
  • A lot of bleeding or any discharge from the incision site
  • Loss of feeling in the affected limb
  • Swelling or pain in the muscles around the broken bone
  • Pain cannot be controlled with the medications you've been given
  • Cough, shortness of breath, or chest pain
  • Joint pain, fatigue, stiffness, rash, or other new symptoms
If you think you have an emergency, call for medical help right away.




RESOURCES:
American Academy of Physical Medicine and Rehabilitation

National Institute of Arthritis and Musculoskeletal and Skin Diseases

CANADIAN RESOURCES:
The Arthritis Society

Canadian Orthopaedic Association

References:
Fractures (broken bones). American Academy of Orthopaedic Surgery website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00139. Updated October 2012. Accessed September 10, 2013.

Total hip arthroplasty. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated July 22, 2013. Accessed September 10, 2013.

6/3/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mills E, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

Last Reviewed September 2013



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