Open Reduction and Internal Fixation (ORIF)

What is ORIF surgery?

Open reduction and internal fixation (ORIF) is surgery to repair broken bones (bone fractures). An orthopedic surgeon will realign (set) your bones to their correct position and then secure them in place so they can heal and grow back together.

Not everyone who breaks a bone needs ORIF surgery. Some types of fractures are more likely to need surgery, including:

• Compound fractures (open fractures).
• Comminuted fractures.
• Displaced fractures (fractures where the pieces of your bone move enough to form a gap).

What happens before ORIF surgery?

Bone fractures are usually caused by traumas like falls, car accidents or sports injuries. So, sometimes there isn’t much time to plan before your healthcare providers decide you need ORIF surgery.

What happens before you have surgery to repair a bone fracture depends on a few factors:

• Which bone is fractured.
• The type of fracture (the fracture pattern).
• The fracture’s severity.
• Its cause.
• Any other injuries you may have.

If you’re taken to the emergency room after a trauma, a team of providers will stabilize you and treat your injuries in the order of severity, especially if some are life-threatening.

After you’re stabilized, you’ll need X-rays to confirm any fractures. Your provider may also use an MRI (magnetic resonance imaging) or CT scan (computed tomography scan) to look for other injuries.

What happens during an open reduction and internal fixation?

Before your surgery, you’ll receive anesthesia to numb your body and make sure you don’t feel any pain. An anesthesiologist will give you either general anesthesia to put you to sleep during the surgery or regional anesthesia to numb the area around your broken bone. They may give you other medications to make you sleep if you need regional anesthesia.

ORIF gets its name from the two parts of the surgery:

• Open reduction: Open reduction means a surgeon makes cuts (incisions) in your skin to access your broken bone and put the pieces back to their natural positions. Open is the medical term for surgery that requires incisions to open your body to let your surgeon see inside it. A reduction is the process of repositioning the pieces of your bone.
• Internal fixation: This is exactly what it sounds like — your surgeon will put pieces of metal into your bone (internally) to hold (fixate) it in place. They’ll use rods, screws, wires, plates or a combination of these fasteners to secure the pieces of your broken bone back together.

During ORIF surgery, your surgeon will:

1. Make incisions in your skin around the broken bone.
2. Set your bone and realign the broken pieces.
3. Perform the internal fixation to hold the pieces of bone in place. How they do this depends on which type of fracture you have. For example, they might put a long titanium rod through the center of a long bone like your shin bone (if you have a tibia fracture), or screw metal plates into either side of your ankle to repair a broken ankle.
4. Close the incisions.
5. Immobilize your bone. Most people will need a cast. You might only need a splint after ORIF. It depends on which bone is broken.

How long does ORIF take?

ORIF surgery usually takes at least a few hours from start to finish. It depends on which type of fracture you have and which bone is broken. Larger, longer bones or more severe fractures usually take longer to repair.

What happens after an open reduction and internal fixation?

After surgery, you’ll be moved to a recovery room. Your surgery team will keep an eye on you for a few hours to make sure you recover from the anesthesia without complications. They’ll also monitor your vital signs and pain level.

Some people who have ORIF surgery go home the same day. You might need to stay in the hospital overnight or for a few days, especially if you have other injuries. Your surgeon will tell you when it’s safe to go home.

What are the advantages of ORIF surgery?

Repairing your damaged bone is the most obvious benefit of ORIF surgery. Severe fractures won’t heal correctly without surgery. A bone that doesn’t heal properly is much more likely to break again in the future. Having ORIF makes sure the pieces of your bone are aligned properly. This will give your bone the best chance to heal without long-term complications.

What is the success rate of ORIF surgery?

ORIF surgery is usually very effective. Success rates depend on which bone is fractured and the fracture pattern. Studies consistently find that ORIF is the best way to treat severe bone fractures that won’t heal with only immobilization.

Even for rare, complex fractures like broken femurs, ORIF has a high rate of success. One study found that around 75% of people who had ORIF to repair a fractured femur had few or no long-term complications.

What are ORIF surgery complications?

ORIF surgery complications include:

• Acute compartment syndrome: A buildup of pressure in your muscles may stop blood from getting to tissue, which can cause permanent muscle and nerve damage.
• Malunion: This happens when your broken bones don’t line up correctly while they heal.
• Nonunion: Your bones may not grow back together fully or at all.
• Bone infection (osteomyelitis): If you have an open fracture (the bone breaks through your skin) you have an increased risk of bacterial infection.
• Blood clots: Having ORIF can increase the risk of blood clots in blood vessels near your broken bone while you recover.

How long does it take to recover after an open reduction and internal fixation?

It depends on which type of fracture and ORIF surgery you have. Some fractures heal in several weeks. More severely broken bones can take a year or longer. You’ll probably need to wear a cast or splint for a least a few weeks. Talk to your provider or surgeon about what to expect while you recover.

Your surgeon will give you a customized recovery plan, but in general, you should:

• Elevate your bone: Keep your bone above the level of your heart as often as possible. You can prop it up on cushions or pillows while lying down.
• Keep your incision clean and covered: Follow your surgeon’s incision care instructions carefully to prevent infections. Ask your surgeon when you should change the dressing on your incision site (if you can access it) and when it’s safe to take a shower or bathe, especially if you’re wearing a cast.
• Physical therapy: You’ll work with a physical therapist for up to a few months after your surgery. Your surgeon will give you instructions on how to move safely before you go home. You might need to use crutches or other assistive devices for a few weeks after ORIF.

Pain management after ORIF surgery

After surgery, you’ll feel pain, especially in the first few weeks of your recovery. You’ll feel pain from the surgery itself and pain as your bone begins to heal.

Your surgeon will suggest a combination of prescription pain medication, over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) — if it’s safe for you to take them — and acetaminophen to relieve your pain. Your surgeon will tell you how much of each kind of medication you can take each day or in a certain amount of time.

Talk to your surgeon if you feel like you’re experiencing too much pain or if you’re worried about any complications from taking pain medication.

Are ORIF screws permanent?

It depends on where you needed an internal fixation. Some people live with the metal pieces inserted in their bones forever. You might need follow-up surgeries to remove them. Ask your surgeon what to expect.

It’s common for screws and plates around joints (especially your ankles) to stay in your bone for the rest of your life. The metal pieces will support your bones even after the fracture heals.

Sometimes, as your bone heals, your body pushes screws or other fasteners closer to your skin’s surface. Talk to your surgeon if you notice pain or other symptoms near the implants.

When should I see my healthcare provider?

Call your surgeon or healthcare provider right away if you experience any of the following symptoms:

• Chest pain.
• Shortness of breath (dyspnea).
• Fever higher than 101 degrees Fahrenheit (39 degrees Celsius).
• Bleeding.
• Signs of infection at your surgery site, including leaking, swelling, discoloration, odor or a feeling of warmth.
• Severe pain that doesn’t get better after you take pain medication.

A note from Cleveland Clinic

Breaking a bone is always scary, and it can be even more of a shock to hear you’ll need surgery to implant pieces of metal into your body. It’s perfectly normal to be worried about healing after a trauma like a bone fracture. But open reduction and internal fixation (ORIF) is one of the best ways to make sure your bone heals in the correct shape and position.

Don’t be afraid to ask your surgeon lots of questions. They’ll explain which type of ORIF is best for you, how long the metal implants will stay in your bone and can discuss any other concerns you might have.