Surgery for a fracture? What you need to know about ORIF surgery! (Open Reduction and Internal Fixation - ORIF)

Imagine that you have an accident and break a bone in your arm or leg. What a terrifying experience! So, the doctor comes and says, "This needs surgery and internal wires and plates to fix it." It's normal to feel even more scared at that moment. But don't be afraid. Today we're talking about ORIF, a special surgery that is used to restore severely broken bones.

What is ORIF surgery? Who needs it?

The full meaning of ORIF is Open Reduction and Internal Fixation . Although the name may sound complicated, the meaning is very simple.

• Open Reduction: This means that the surgeon cuts the skin, opens it up, takes the broken bone fragments and puts them back in their proper place, much like putting broken pieces of glass back together.
• Internal Fixation: This means that the bone fragments that have been placed in the right place are fixed together without moving, and are fixed by inserting metal parts (for example, screws, plates, rods, or wires) from the inside.

Not everyone with a broken bone needs this surgery. Sometimes a cast can be used to heal the fracture. However, for some severe fractures, ORIF surgery is necessary.

What happens before surgery?

Most fractures occur suddenly, such as a fall, car accident, or sports injury. So there is no time to plan these surgeries in advance. After you are brought to the Emergency Department (ETU), the medical team's first task is to assess your life-threatening condition, manage those conditions, and stabilize you.

Then, an X-ray is done to confirm the fracture. Sometimes, the doctor may also decide to do a CT scan or MRI scan to look more closely at the fracture and any damage to the surrounding muscles.

What happens during the surgery?

Before the surgery begins, you will be given anesthesia so that you will not feel any pain. Depending on your condition and the nature of the surgery, the anesthesiologist will either give you general anesthesia, which puts you completely to sleep, or regional anesthesia, which numbs only the area where the bone is broken.

The surgeon then follows these steps:

1. Skin incision: The skin is cut over the broken bone and goes down to where the bone is.

2. Reduction: The broken and dislocated bone fragments are carefully removed and repositioned according to their original position.

3. Internal Fixation: Now, to prevent the bone fragments from shifting again, they are fixed together with metal screws, plates, or rods. For example, if the tibia is broken, a long titanium rod can be inserted through the middle of the bone. If the ankle is broken, metal plates can be inserted on both sides and fixed with screws.

4. Stitching the wound: Once the bone is fixed, the cut wound is stitched back together.

5. Immobilization: Finally, a cast or splint is placed on the operated arm or leg to prevent movement.

This surgery can usually take several hours, depending on the nature of the broken bone and the severity of the fracture.

What happens after the surgery?

After surgery, you will be taken to a recovery room. There, the medical team will take good care of you until you have fully recovered from the anesthesia and are sure there are no other complications. While some people are able to go home the same day, most people will need to stay in the hospital for a day or two. This will be determined by your doctor based on your condition.

ORIF surgery is generally very successful, even in rare, complex fractures.

What are the possible complications?

As with any surgery, ORIF surgery can rarely cause complications. There is nothing to be afraid of, but it is important to be aware of this.

How long does it take to recover?

The time it takes to fully heal will vary depending on the nature of your fracture. Some fractures heal in a few weeks, while more severe fractures can take months or even a year to heal. You may need to wear a cast for several weeks. Take care of these things while you are healing.

• Elevate the arm/leg: Whenever possible, keep the operated arm/leg elevated above the level of the heart with pillows. This will reduce swelling.
• Keep the wound clean: To prevent infection, keep the wound clean and covered as directed by your doctor. Listen carefully to instructions on how to change the wound's bandage and when you can shower.
• Physical Therapy: As the bone heals, physical therapy is essential to strengthen the surrounding muscles and joints. You may need to use assistive devices such as crutches.

How to control pain?

It is normal to feel some pain after surgery, especially in the first few weeks. Your doctor will prescribe pain medication to help control the pain. It is important to take the medication at the right dose and at the right time. If the pain is unbearable, let your doctor know right away.

Are the metal parts (screws, plates) inserted permanently?

This is a problem for many people. For some people, these metal parts remain in their bodies throughout their lives. Plates and screws, especially those placed in joints like the ankle, are not removed because they provide extra strength even after the bone has healed. However, in some cases (for example, if they cause discomfort or are placed in growing bones in children), they are removed later with a minor surgery. It is best to ask your surgeon about this and explain it to him.

When to seek immediate medical advice

If you develop any of the following symptoms during your recovery, call your doctor immediately or go to the nearest hospital Emergency Department (ETU).

• Severe chest pain.
• Difficulty breathing (Dyspnea).
• Fever above 38° Celsius (101° Fahrenheit).
• Excessive bleeding from the surgical wound.
• Signs of infection at the wound site (pus discharge, excessive swelling, discoloration, odor, or a feeling of extreme warmth).
• Severe pain that cannot be controlled even with painkillers.

Breaking a bone is a traumatic experience. It's natural to be scared when you hear about surgery and metal pieces being inserted into your body. But remember, ORIF surgery is the best and safest way to properly heal a severe fracture. Talk openly with your doctor about any questions or concerns you may have.

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