Open Reduction and Internal Fixation (ORIF) is a surgical procedure designed to repair severe bone fractures. This two-part technique involves first surgically exposing and realigning the broken bone fragments, which is the “open reduction.” Following this realignment, the “internal fixation” component uses specialized metal implants to hold the bone pieces securely in place while they heal. The overall purpose of ORIF is to restore the bone’s original shape and length, ensuring proper healing and maximizing the return of function to the injured limb.
When Open Reduction and Internal Fixation is Required
Open Reduction and Internal Fixation is a treatment reserved for fractures that cannot be successfully managed using non-surgical methods like casting or splinting alone. When a broken bone is severely displaced, meaning the fragments have shifted significantly out of their normal anatomical position, a closed reduction may not be possible or stable enough. The fracture must be precisely realigned to prevent a malunion, which is a bone healing in an incorrect position or angle, often leading to long-term pain and functional impairment.
This procedure is often necessary for unstable fractures, where the bone pieces tend to move or shift after any initial attempt at alignment. Complex fractures, such as comminuted breaks where the bone has shattered into three or more pieces, also typically require ORIF for stabilization. Without internal fixation, these multiple fragments would be impossible to hold together accurately during the natural healing process.
Fractures that involve a joint surface, known as intra-articular fractures, usually necessitate ORIF to ensure the smooth cartilage surface is perfectly reconstructed. Even a small step-off or gap in the joint surface can lead to premature wear and tear, potentially causing post-traumatic arthritis years later. Another indication for this surgery is an open or compound fracture, where the broken bone pierces the skin, exposing the bone and surrounding tissue to potential contamination.
In some cases, soft tissue, such as muscle or ligament, can become trapped between the bone fragments, physically blocking the bones from being reduced back into place. When this interposition occurs, an open surgical approach is required to physically clear the tissue before the bone can be realigned. ORIF is the standard of care for serious injuries where precise anatomical restoration is required to restore long-term function.
The Steps of the Surgical Procedure
The ORIF procedure is performed in a sterile operating room, typically under general or regional anesthesia. The first step is the “open reduction,” which begins with the orthopedic surgeon making a surgical incision directly over or near the fracture site. The length and location of this incision depend on the specific bone and the complexity of the fracture pattern.
Once the soft tissues are carefully retracted, the surgeon gains direct visual access to the broken bone fragments. This direct visualization distinguishes the open reduction from a closed reduction, which is performed by manipulating the bone from outside the skin. The surgeon then manipulates the pieces of the fractured bone to realign them precisely into their original anatomical position. This stage is crucial for restoring the bone’s native length, rotation, and alignment.
After the bone fragments have been reduced, the second step, “internal fixation,” begins. This involves implanting orthopedic hardware to secure the realigned fragments. The choice of hardware is tailored to the specific fracture, but common options include plates, screws, rods, pins, or wires, often made from biocompatible materials like stainless steel or titanium.
Plates are contoured to the bone and secured with multiple screws drilled through the plate and into the bone on either side of the fracture. For fractures in the long bones of the leg or arm, the surgeon may use an intramedullary rod. This long metal rod is inserted down the hollow center of the bone, providing strong internal support. It is locked into place at both ends with screws to prevent rotation or shortening of the bone.
The hardware stabilizes the fracture site, providing a rigid framework that allows the body’s natural healing processes to form new bone. Once the fixation is complete and confirmed using an intraoperative X-ray device called fluoroscopy, the surgeon closes the incision layers with sutures or staples. A sterile dressing is applied, and often a cast or splint is placed externally for additional protection during the initial recovery phase.
Recovery and Rehabilitation Following ORIF
The recovery process begins immediately after the procedure, with the patient being transferred to a recovery area for close monitoring and initial pain management. Post-operative pain is managed using a combination of medications, including narcotics and non-steroidal anti-inflammatory drugs (NSAIDs). Infection prevention is addressed with a course of prophylactic antibiotics following the surgery.
Managing post-operative swelling is achieved by keeping the injured limb elevated above the level of the heart as much as possible. The patient is typically discharged from the hospital within a few days, depending on the fracture location and their general health status.
A defining element of recovery is the weight-bearing restriction placed on the injured limb, which is determined by the surgeon. For lower extremity fractures, a period of non-weight bearing is required for several weeks, often ranging from four to twelve weeks. This restriction protects the internal fixation hardware and allows the bone to begin fusing without mechanical stress.
Physical therapy is a core component of rehabilitation and usually begins once the surgeon determines the fracture is stable enough, often around six to twelve weeks post-surgery. The initial goals of physical therapy are to restore the joint’s range of motion and reduce stiffness caused by immobilization. As healing progresses, the focus shifts to strengthening the surrounding muscles and gradually reintroducing weight-bearing activities.
Full recovery, meaning the bone is completely healed and function is maximized, can take anywhere from three months to a full year. The internal fixation hardware is often left in place permanently. However, if the hardware causes irritation, pain, or limits motion, a second surgery may be scheduled after the bone has fully healed to remove the plates, screws, or rods.