Open reduction and internal fixation (ORIF) surgery

What is open reduction and internal fixation (ORIF) surgery

Open reduction and internal fixation (ORIF) surgery is a procedure to repair a bone fracture. “Open reduction” means the surgeon makes an incision to access and reposition the broken bones. “Internal fixation” refers to holding the pieces in place with hardware like screws, plates, or rods. The hardware may remain permanently or be removed once the fracture has healed. 

ORIF surgery helps align a broken bone. Placing and holding the bone in the correct position gives you the best chance to heal and experience an optimal outcome. It helps avoid the complications of an improperly healed bone (malunion), which may appear malformed, cause persistent pain, limit your mobility, and be more likely to break again. It also reduces the risk of broken bone pieces not connecting as they heal (nonunion).  

At Penn Orthopaedics, we offer the full range of care for fractures, including ORIF surgery. 

Who is a candidate for ORIF surgery?

ORIF surgery is often recommended for a fracture when proper healing is unlikely through nonsurgical approaches alone, such as setting with a cast or splint. Candidates typically include people with:

  • Broken bones that are displaced (misaligned) or in multiple pieces
  • Breaks that involve a joint or are close to one
  • Open or compound fractures, meaning the bone has created an open wound or break in the skin

ORIF surgery is often performed soon after an injury occurs. ORIF may also be a corrective solution for when the bone fracture was previously set but has healed in the wrong position (malunion) or the broken pieces have failed to reconnect (nonunion). Our orthopaedic surgeons have decades of expertise in surgical reconstruction of nonunion and malunion fractures.

What to expect from ORIF surgery

The location and complexity of your fracture will affect the length of surgery, time spent in the hospital, pain management, and other aspects of your treatment plan. Your care team will discuss the specific details of your treatment with you, though you can generally expect: 

  • Before surgery, you’ll be evaluated with a physical exam and imaging (x-ray, CT scan, or MRI). If the surgery does not need to be performed immediately, you’ll be given instructions on when to stop taking certain medications and aL
  • You’ll be given general anesthesia so you are unconscious during the surgery and pain-free. 
  • Your surgeon will make an incision at the site of the fracture in order to access the damaged bone.  
  • Broken pieces of bone will be realigned so they are in their proper position. 
  • Hardware such as screws, plates, rods, or pins will be used to fix the bones in place and keep them stable as they heal. 
  • The incision will be closed with stitches or staples. 

Recovery from ORIF surgery

Depending on the severity of your fracture and your overall health, full recovery may take from three months to a year. Steps in your healing process may include:  

  • Wearing a cast, splint, or brace 
  • Pain management with prescribed medications 
  • Physical therapy to regain strength and mobility 
  • Follow-up appointments to monitor healing 
  • Gradual resumption of regular activities 

The hardware usually remains in place unless it is causing discomfort or limiting movement. If hardware removal after ORIF surgery is advised, it often happens within the first year.  

Leaders in orthopaedic fracture care

Penn Medicine is internationally recognized for its innovative approaches to orthopaedic trauma. We offer the most complete trauma and fracture care in the southeastern Pennsylvania and New Jersey regions. We provide treatment for simple to severe and complex cases, including reconstructing the damaged soft tissues that may accompany a fracture, such as torn tendons, ligaments, and muscles.  

We take a whole-body approach to care and surround you with a dedicated team that works to understand who you are and how you want to live. Our goal is to help you return to your regular activities as soon as possible with the right treatment and rehabilitation. 

Our trauma and fracture care services are guided by advanced research conducted in our specialized labs. We investigate new orthopaedic techniques and treatments, seek to improve patient outcomes, and train the next generation of leaders in the field. 

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