Open reduction internal fixation (ORIF) surgery repairs severe bone breakages. Surgeons perform ORIF surgery on severely broken bones when a cast or splint will not suffice.

ORIF surgery is a major and sometimes emergency operation that may help relieve pain, restore mobility, and heal the bone in the correct position.

This article examines ORIF surgery in more detail, including the procedure, recovery time, and possible risks and complications. It also discusses whether there are alternatives to ORIF surgery.

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ORIF surgery is a two-step process that involves:

  1. open reduction
  2. internal fixation

Open reduction is where a surgeon makes an incision to access the affected bones and reset them to their proper place.

Internal fixation is where a surgeon keeps the bone in place while healing. They do this by using:

  • plates
  • screws
  • nails
  • rods
  • wires
  • pins

Depending on the circumstances, the surgeon will decide whether to permanently leave the internal fixation devices or remove them once the bone heals.

A person has general anesthesia for both steps of this surgery.

People may need ORIF surgery if they have severely broken a bone in their arm or leg, such as the:

  • ankle
  • shoulder
  • elbow
  • wrist
  • hip
  • knee

A doctor may suggest ORIF surgery if a:

  • cast or splint does not heal the bone
  • bone breaks in multiple places
  • bone has fallen out of alignment
  • bone sticks through the skin
  • joint becomes dislocated
  • closed reduction has not worked

There are some risks associated with all surgeries, such as:

The likelihood of these complications is rare.

ORIF surgery, in particular, also carries the following risks:

  • nerve damage
  • damage to blood vessels, ligaments, muscles, or bones
  • parts of the arm or leg moving out of place
  • pain
  • swelling
  • stiffness or numbness
  • mobility difficulties
  • bones that do not heal
  • muscle or tissue damage
  • blood clots
  • muscle spasms
  • fat embolism
  • skin issues

Some people may have an increased risk of complications if they have diabetes, low bone mass, or smoke cigarettes.

In a small 2017 study, researchers assessed 235 people who had ORIF surgery. They found that 5.1% developed a surgical site infection. Most of these happened while the person was in the hospital recovering.

The researchers also concluded that habitual smoking increases the risk of surgical site infection.

ORIF surgery is usually an emergency or urgent procedure. Due to its urgency, there is generally little to no preparation before surgery, which may occur on admittance to a hospital.

Sometimes, a surgeon may advise waiting until the swelling reduces before they operate.

Before the procedure, a healthcare professional performs an X-ray of the area to help them view the bones properly. It also allows them to assess the breakage to prepare for surgery.

A doctor will perform a physical exam and discuss the details of the surgery with the individual. They will also list any possible risks of the procedure and answer any questions the person may have.

People will have a general anesthetic before ORIF, meaning they will be unconscious and unaware of the surgery.

Surgery can take multiple hours, depending on the location and severity of the fracture.

Following surgery, a person will spend time in the hospital until the effects of the anesthesia wear off. Healthcare professionals may monitor their circulation, sensation, and movement before they can go home.

Some people can leave on the same day. Others may need to stay for monitoring overnight or for a few days.

Full recovery after ORIF surgery can take around 3–12 months. Recovery time depends on the location and severity of the fracture and whether there were complications during surgery.

A few factors that may help a person’s recovery include:

  • partaking in physical therapy to help regain mobility
  • taking recommended pain relief medication
  • keeping the limb elevated above the heart for at least 48 hours
  • applying regular ice packs to reduce swelling
  • keeping the dressing on and cleaning for the recommended time
  • checking with a doctor when it is OK to wash the area
  • not putting weight on the area and making use of any provided crutches, wheelchairs, or slings

A person should tell doctors, including dentists, that they have internal metal hardware in case they need to take a course of antibiotics to avoid infections during other procedures.

The outlook for people who have ORIF surgery is good. It is usually a necessary surgery for severely broken bones and can help a person regain the appropriate use of their limb.

Research suggests that complications following ORIF surgery are not uncommon. However, the outcome is generally favorable when doctors promptly identify any issues and manage them appropriately.

Following ORIF surgery, an individual should not hesitate to contact a doctor if they suspect there is an issue.

A person usually receives ORIF surgery as a final resort if doctors cannot reset a bone using a splint or cast. Therefore, this means there are very few alternative procedures.

Some different operations may be possible depending on the location of the break. However, ORIF is likely necessary if the break is severe.

People often require ORIF surgery if they have severely broken bones.

It consists of open reduction and internal fixation, involving doctors resetting the bones and using rods and other instruments to fix them.

Surgery can take multiple hours. However, individuals typically spend only a short time in the hospital during recovery.

As with all surgeries, ORIF carries some risks. Minor complications are possible but are usually treatable.