ORIF (open reduction and internal fixation) surgery typically takes one to three hours of actual operating time, though the total time you spend in the surgical area, from anesthesia to the recovery room, is longer. The biggest factor is which bone is broken and how complex the fracture is. A straightforward wrist fracture can be finished in under an hour, while a shattered thighbone may take several hours.
Typical Operating Times by Fracture Location
The bone involved is the single biggest predictor of how long you’ll be in the operating room. Larger bones with more surrounding muscle require more time to access, realign, and secure with plates, screws, or rods.
Wrist fractures are among the fastest ORIF procedures. A study of over 17,000 distal radius (wrist) fractures found an average operating time of about 75 minutes, with most cases falling in the 30 to 90 minute range. The 60-minute mark appears to be a meaningful cutoff: cases that run longer tend to involve more complex fracture patterns and are associated with higher rates of complications and longer recovery room stays.
Ankle fractures generally take one to two hours, depending on whether one, two, or all three parts of the ankle joint are involved. A single-side break with a clean fracture line sits at the shorter end. A trimalleolar fracture, where all three sides of the ankle are broken, pushes toward two hours or more because the surgeon needs to place hardware in multiple locations.
Hip and femur (thighbone) fractures tend to be the longest. These are large, weight-bearing bones surrounded by thick muscle, and the hardware involved is substantial, often a long metal rod or large plate system. Two to three hours is common, and complex fractures can extend beyond that. For elderly patients with hip fractures, current guidelines recommend surgery within 24 hours of hospital admission when possible, and within 48 hours at most, because delays are associated with worse outcomes, longer hospital stays, and higher complication rates.
What Adds Time to the Procedure
A clean break through a bone is far simpler to repair than one that has shattered into multiple fragments. Comminuted fractures, where the bone has broken into three or more pieces, require the surgeon to reconstruct a kind of jigsaw puzzle, carefully positioning each fragment before securing it. This can easily double the operating time compared to a two-piece break in the same bone.
Soft tissue damage also matters. If the surrounding muscles, tendons, or blood vessels are injured, the surgeon needs to work around or repair that damage before addressing the bone itself. Fractures near joints take longer because the alignment has to be precise to preserve normal movement afterward. Even a millimeter or two of misalignment at a joint surface can cause long-term problems, so the surgeon will spend extra time checking positioning with X-ray imaging during the procedure.
Previous surgery on the same bone, obesity, and the patient’s overall bone quality all play a role too. Osteoporotic bone doesn’t grip screws as firmly, so the surgeon may need to use different hardware or additional fixation points, adding time.
Total Time Away From Your Room
The operating time your surgeon quotes you is only part of the picture. Before the first incision, there’s a preparation phase that includes checking in to the pre-operative area, placing an IV, administering anesthesia, positioning your body on the operating table, and sterilizing and draping the surgical site. This adds roughly 30 to 45 minutes before surgery begins. One study found that the total anesthesia time averaged around two hours even for procedures where the cutting itself was shorter, simply because of the setup and emergence process on either end.
After the procedure, you’ll spend time in the recovery room (called the PACU) while the anesthesia wears off. This phase typically lasts 60 to 90 minutes, though it varies. Nurses monitor your vital signs, manage pain, and make sure you’re alert and stable before moving you back to your hospital room or, for outpatient cases, to a discharge area.
So if your surgeon says the operation itself should take about 90 minutes, plan on being away from your room for roughly three to four hours total.
Minimally Invasive Alternatives Are Faster
For certain fractures, surgeons can use a less invasive version of the procedure called MIPO (minimally invasive plate osteosynthesis). Instead of making one large incision to fully expose the bone, the surgeon makes smaller incisions and slides a plate into position using specialized instruments and imaging guidance.
A meta-analysis of 13 studies covering over 900 patients with upper arm fractures found that MIPO reduced operating time by about 21 minutes on average compared to traditional ORIF. The minimally invasive approach also resulted in less blood loss, less postoperative pain, and faster bone healing. Not every fracture is a candidate for this technique, but it’s worth asking your surgeon whether it’s an option for your specific injury.
What to Expect the Day of Surgery
You’ll typically be asked to stop eating and drinking at midnight before your procedure. Arrive at the hospital or surgery center one to two hours before your scheduled time to allow for check-in, paperwork, and the pre-operative preparation. Most ORIF procedures use general anesthesia, meaning you’ll be fully asleep, though some ankle and wrist surgeries can be done with regional anesthesia that numbs only the affected limb.
Whether you go home the same day depends on the fracture location and your overall health. Wrist and some ankle fractures are increasingly done as outpatient procedures, meaning you leave the same day once the anesthesia has fully cleared and your pain is manageable. Hip and femur fractures almost always require at least a few days in the hospital. Elderly patients with hip fractures may stay longer, particularly if they need physical therapy before they can safely move around at home.
The hardware placed during surgery, plates, screws, rods, or pins, is usually permanent. In some cases, especially in younger patients or when hardware causes irritation, a second shorter procedure to remove it may be scheduled months later after the bone has fully healed.