Open Reduction and Internal Fixation (ORIF)

Also known as: ORIF (open reduction internal fixation), Open reduction internal fixation, Open reduction with internal fixation, Open reduction and internal fixation surgery, Surgical fracture fixation, Internal fixation surgery, Fracture repair with plates and screws, Bone fracture surgery with hardware

Last updated: December 18, 2024

Open reduction and internal fixation (ORIF) is a procedure used to realign broken bone fragments and stabilize them with implanted hardware such as plates, screws, nails, or rods. It may be considered for displaced or unstable fractures, including those involving a joint surface, when alignment may be hard to maintain with casting or splinting alone. Risks can include infection. Recovery often takes weeks to months; early care may include pain, swelling, wound checks, and limb circulation monitoring.

Key Facts

•Open reduction and internal fixation (ORIF) be used to realign broken bone fragments (open reduction) and stabilize them with implanted hardware such as plates, screws, nails, or rods (internal fixation)
•Considered when conservative treatment has not provided adequate symptom relief
•Performed under anesthesia, replacing damaged joint surfaces with artificial components
•Recovery involves physical therapy over weeks to months, with gradual return to activities

Overview

Open reduction and internal fixation (ORIF) may be used to realign broken bone fragments (open reduction) and stabilize them with implanted hardware such as plates, screws, nails, or rods (internal fixation). It can be considered when a fracture is displaced, unstable, involves a joint surface, or may be difficult to maintain in alignment with casting or splinting alone. The procedure typically aims to restore bone alignment and stability to support healing and function, and it can also help reduce the risk of malalignment-related problems. Recovery often spans weeks to months and can vary based on fracture type, location, soft-tissue injury, and overall health factors.

Indications

This procedure may be considered when:

•Displaced fractures where bone fragments may not align adequately with closed reduction and casting or splinting.
•Unstable fracture patterns (for example, comminuted fractures) where alignment may be difficult to maintain without internal support.
•Intra-articular fractures where joint surface restoration can be important to reduce the likelihood of stiffness and post-traumatic arthritis.
•Open fractures after initial wound management, where internal fixation may be used as part of definitive stabilization depending on contamination and soft-tissue status.
•Fractures associated with neurovascular compromise or compartment concerns where urgent stabilization and decompression planning may be needed.
•Nonunion or malunion scenarios where revision fixation and realignment may be considered to improve stability and function.
•Certain hip, ankle, wrist, and long-bone fractures where early stability may support rehabilitation and function depending on patient and fracture factors.

How It Works

The procedure typically involves several coordinated steps:

•Preoperative planning can include fracture classification, review of X-rays/CT imaging, and selection of fixation strategy (plate-and-screw constructs, intramedullary fixation, or screw fixation).
•Patient positioning may be selected to permit fracture reduction maneuvers and intraoperative imaging; padding can be used to reduce pressure injury risk.
•After anesthesia, the operative limb may be prepped and draped in a sterile fashion; a tourniquet can be used for some extremity procedures depending on surgeon preference and clinical context.
•A surgical approach may be chosen to balance fracture exposure with soft-tissue preservation; dissection can proceed through tissue planes to reach the fracture site.
•Hematoma and interposed tissue may be cleared to visualize fracture edges; care can be used to preserve periosteal blood supply where feasible.
•Reduction may be achieved by restoring length, alignment, and rotation; tools such as reduction clamps, joysticks (temporary pins), traction, or external manipulation can be used.
•Temporary fixation can hold the reduction while definitive hardware is applied; K-wires or clamps may serve as provisional stabilizers.
•Definitive fixation may be applied using plates and screws (including locking plates), lag screws for compression, intramedullary nails/rods for long bones, or a combination construct depending on fracture mechanics.
•Intraoperative fluoroscopy can confirm reduction quality, joint surface congruity, screw lengths, and implant position; adjustments can be made to reduce malposition risk.
•If bone loss or comminution is present, bone graft or bone graft substitutes can be used in selected cases to support healing biology and structural stability.
•Final stability can be assessed through gentle range-of-motion testing (when appropriate) and imaging confirmation; the wound can be irrigated to reduce bacterial load.
•Layered closure can restore soft-tissue coverage; dressings and immobilization (splint/brace) may be applied, and a postoperative plan can outline weight-bearing status and rehabilitation progression.

Risks

As with any surgical procedure, potential risks include:

•Infection (superficial or deep), which can include hardware-associated infection and may require additional procedures or prolonged antimicrobial therapy.
•Bleeding or hematoma formation, which can contribute to wound complications or delayed healing in some cases.
•Damage or irritation to nearby nerves or blood vessels, which can present as numbness, weakness, or circulation changes.
•Blood clots (deep vein thrombosis or pulmonary embolism), with risk influenced by fracture location, immobility, and patient-specific factors.
•Delayed union or nonunion (slower or incomplete bone healing), which can be influenced by fracture severity, blood supply, smoking status, and systemic health conditions.
•Malunion or loss of reduction, where alignment may shift despite fixation, potentially affecting function or limb mechanics.
•Hardware-related problems such as loosening, breakage, prominence, tendon irritation, or pain; hardware removal can be considered in selected scenarios.
•Joint stiffness, reduced range of motion, or post-traumatic arthritis, particularly when the fracture involves a joint surface or prolonged immobilization is required.
•Compartment syndrome (more commonly related to the injury than the fixation), which can be limb-threatening and may require urgent surgical decompression.
•Anesthesia-related complications such as nausea, sore throat, cardiopulmonary events, or reactions, with likelihood influenced by anesthesia type and health status.

Recovery Expectations

Recovery follows a gradual progression:

•First 24–72 hours: Monitoring often focuses on pain control, swelling management, wound care instructions, and repeated checks of sensation, movement, and circulation in the affected limb.
•First 1–2 weeks: A follow-up visit can include incision evaluation and suture/staple removal timing when applicable; immobilization (splint/brace) may continue depending on fracture stability and soft-tissue status.
•Weeks 2–6: Gentle range-of-motion therapy can be introduced for many fractures when permitted by fixation stability; swelling and stiffness may gradually improve during this span.
•Weeks 6–12: Early radiographic signs of healing can often be assessed; progression of activity or weight-bearing may be considered based on imaging, pain, and surgeon protocol.
•Months 3–6: Many patients can experience substantial functional gains with rehabilitation; return to higher-demand activities can require this span or longer depending on fracture type and occupation/sport demands.
•Months 6–12: Remodeling and strength recovery can continue; residual stiffness, discomfort, or sensitivity around hardware can persist in some cases during this span.
•Variable timeline: Complex fractures, open injuries, infection, or nonunion can extend recovery and may require additional procedures or prolonged rehabilitation.

Alternatives

Depending on individual circumstances, alternatives may include:

•Closed reduction with casting or splinting, which can be used for stable or acceptably aligned fractures.
•External fixation, which can provide stabilization with pins and an external frame, often used for severe soft-tissue injury, open fractures, or staged management.
•Percutaneous fixation (for example, pinning or screw fixation through small incisions), which can be used for selected fracture patterns.
•Intramedullary nailing as a primary strategy for certain long-bone fractures, which can be considered a distinct fixation approach compared with plate-based ORIF.
•Nonoperative functional bracing for selected fractures where alignment and stability can be maintained without open surgery.
•Arthroplasty (joint replacement) for certain fractures in older adults or when joint reconstruction may be less feasible, such as some displaced femoral neck fractures.
•Bone grafting or biologic augmentation as an adjunct in delayed union/nonunion scenarios, sometimes combined with revision fixation.

Ankle Fracture(Condition)
Clavicle Fracture (Broken Collarbone)(Condition)
Hip Fracture (Proximal Femur Fracture)(Condition)
Distal Radius Fracture (Wrist Fracture; including Colles and Smith fracture patterns)(Condition)

Frequently Asked Questions

This procedure may be considered when: Displaced fractures where bone fragments may not align adequately with closed reduction and casting or splinting.; Unstable fracture patterns (for example, comminuted fractures) where alignment may be difficult to maintain without internal support.; Intra-articular fractures where joint surface restoration can be important to reduce the likelihood of stiffness and post-traumatic arthritis.; Open fractures after initial wound management, where internal fixation may be used as part of definitive stabilization depending on contamination and soft-tissue status..

Potential risks include: Infection (superficial or deep), which can include hardware-associated infection and may require additional procedures or prolonged antimicrobial therapy.; Bleeding or hematoma formation, which can contribute to wound complications or delayed healing in some cases.; Damage or irritation to nearby nerves or blood vessels, which can present as numbness, weakness, or circulation changes.; Blood clots (deep vein thrombosis or pulmonary embolism), with risk influenced by fracture location, immobility, and patient-specific factors.; Delayed union or nonunion (slower or incomplete bone healing), which can be influenced by fracture severity, blood supply, smoking status, and systemic health conditions..

Recovery typically involves: First 24–72 hours: Monitoring often focuses on pain control, swelling management, wound care instructions, and repeated checks of sensation, movement, and circulation in the affected limb.; First 1–2 weeks: A follow-up visit can include incision evaluation and suture/staple removal timing when applicable; immobilization (splint/brace) may continue depending on fracture stability and soft-tissue status.; Weeks 2–6: Gentle range-of-motion therapy can be introduced for many fractures when permitted by fixation stability; swelling and stiffness may gradually improve during this span.; Weeks 6–12: Early radiographic signs of healing can often be assessed; progression of activity or weight-bearing may be considered based on imaging, pain, and surgeon protocol..