Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery.
Miho J. Tanaka, MD, is a board-certified orthopedic surgeon who specializes in the treatment of sports medicine injuries.
Open reduction internal fixation (ORIF) is a surgical approach that's used for repairing certain types of bone fractures.
An open reduction is an invasive surgical bone realignment, as opposed to a closed reduction that's done without surgery or an incision. Internal fixation is the surgical insertion of hardware to stabilize and hold the bone in place as it heals.
After ORIF, your recovery will depend on several factors—the severity of your injury, the type of bone involved, your post-operative rehabilitation, and your age.
ORIF is a two-part surgery performed by an orthopedic surgeon, with anesthesia for pain control. The steps are broadly outlined as follows:
Internal fixation devices include metal plates and screws, stainless steel pins (Kirschner wires, K-wires), and stabilizing rods that are placed into the cavity of the bone (intramedullary nails, IM nails).
You might have a cast placed after your surgery. Different types of casts may be used during your healing process. You might start with a non-weight-bearing cast to use with crutches for the initial stage of your recovery, followed by a weight-bearing cast as healing advances.
While some orthopedic implants are designed to stay in the body permanently, sometimes a follow-up surgery may be needed to remove an implant that was placed to temporarily support the bone during healing. This is sometimes the case with a severe fracture of the tibia (shin bone) or femur (thigh bone), or when an external device (external fixator) is used.
Physical therapy, as structured by your surgeon and under the care of a licensed specialist, can help you safely restore your strength, endurance, and range of motion.
Immobilization leads to muscle atrophy and weakening of ligaments and tendons. Physical therapy is key to post-recovery success.
Side effects of ORIF procedures can include bacterial infection, nerve damage, decreased range of motion, and in some cases, arthritis. Shortening of a limb or another deformity may occur—but you could be at risk of these complications if you don't undergo surgery, as well.
Discuss the risks, benefits, and treatment options with your surgeon to determine the best course of treatment for you.
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Frangie R. Ankle Fracture: Open Reduction and Internal Fixation. Operative Dictations in Orthopedic Surgery. 2013:231-233. doi:10.1007/978-1-4614-7479-1_64
Rasouli MR, Viola J, Maltenfort MG, Shahi A, Parvizi J, Krieg JC. Hardware Removal Due to Infection after Open Reduction and Internal Fixation: Trends and Predictors. Arch Bone Jt Surg. 2015;3(3):184–192
American College of Surgeons. "ACS TQIP: Best Practices in the Management of Orthopedic Trauma." Chicago, Illinois; 2014.
Frangie R. Ankle Fracture: Open Reduction and Internal Fixation. Operative Dictations in Orthopedic Surgery. 2013:231-233. doi:10.1007/978-1-4614-7479-1_64
Rasouli MR, Viola J, Maltenfort MG, Shahi A, Parvizi J, Krieg JC. Hardware Removal Due to Infection after Open Reduction and Internal Fixation: Trends and Predictors. Arch Bone Jt Surg. 2015;3(3):184–192
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