Open reduction and internal fixation (ORIF)

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What is open reduction and internal fixation (ORIF)?

Open reduction and internal fixation is a surgical procedure for repairing fractured bone using either plates, screws or an intramedullary (IM) rod to stabilise the bone. It is used to repair severely displaced or open bone fractures where the fracture has pierced the skin.

What does ORIF involve?

Open reduction means that the broken bone is realigned during surgery (an “open” procedure) rather than a closed reduction, which is performed without the need for surgery. Internal fixation refers to the components that are used to stabilise the bone (screws, plates or rods).

ORIF is a two-stage process that is carried out in one procedure. The first stage repositions the broken bones and restores their normal alignment. This is called fracture reduction. The second stage – internal fixation – is where the broken bones are held together using metal implants.

The surgeon places the metal implants on the surface of the broken bone or inside it. These hold the bones in place while the fracture heals. Surgery can only be performed when the wound is clean, the pieces of the bone are properly aligned and there is minimal soft tissue or skin damage. The procedure may be delayed if the soft tissues need time to heal.

In some cases, your consultant may use external fixation (metal pins in the bone above and below the fracture site held together with rods like scaffolding) to stabilise the bone while it heals. The pins and screws project out of the skin and are attached to metal or carbon fibre bars. They are removed once the bones are sufficiently healed or are ready to be changed to internal fixation devices.

Why might I need ORIF?

A fracture is a break in the bone, often caused by a fall, accident or impact. An open fracture is a fracture that has also caused injury to the overlying skin, increasing the risk of infection. There may be skin loss and the bone may be protruding through the wound. Damage to the muscles, tendons, arteries, veins and nerves can be extensive and there may be fragments of fractured bone as well as foreign objects (dirt, glass, mud, pieces of clothing) in the wound. The greater the damage to soft tissue and bone, the greater the risk of infection.

By contrast, a closed fracture is one where the bone does not tear through the skin. Most open fractures are caused by a high-impact event such as a sports injury, serious fall or car accident.

How long does it take to recover?

It depends on the type and extent of the fracture and whether it has become infected. A bone infection can be difficult and time-consuming to treat, requiring long-term antibiotics and multiple surgical procedures. In the worst cases, if the infection cannot be cured and your life is in danger, the limb may have to be amputated. This is why it is so crucial to try and prevent infection.

After surgery the repaired bone will be immobilised using a sling, cast or splint to allow time for the fracture to heal. Exact healing time will depend on the extent of the fracture and skin damage, whether there is any infection and other factors such as your age. You may be given a course of antibiotics after surgery to help prevent infection and the wound will be checked regularly for signs of infection.

Recovery can be painful and you will be given painkillers and anti-inflammatory medication. Physiotherapy is important to restore strength to the muscles, ligaments and tendons and improve range of movement.

What is the long-term impact of ORIF?

It can take several months to return to your normal day-to-day activities after ORIF surgery, dependent on the extent of the fracture, and you may experience stiffness, discomfort and weakness for some time afterwards. Most people make a good recovery but your consultant will discuss the on-going impact your injury may have on your work, family and everyday life.