Open reduction internal fixation (ORIF) is an orthopedic surgical procedure which is utilized to treat severe fractures. The hip is a bone which commonly requires an ORIF procedure after a fracture, although this procedure can be performed on other bones in the body as well. It is usually done in a sterile operating environment by an orthopedic surgeon with a support team which includes an anesthesiologist to manage the patient along with operating room nurses to assist with tools, maintenance of a sterile environment, and positioning the patient.
There are two separate components for this procedure. The first is the “open reduction” part, which refers to using open surgery to set the bones. Open surgery may be required when a fracture is complex or there are many pieces of bone. The surgeon makes an incision in the area of the break to access the involved bone or bones, and manipulates them back into place, checking with an x-ray machine to confirm that the fracture has been fully addressed.
The internal fixation involves the use of pins, plates, and screws to hold the bones in place. This is done because the bones cannot heal with casting or splinting alone. The internal fixators hold the bones together as they begin to heal. Sometimes they are simply left in place, and in other instances, they may be removed when healing is complete. Healing is monitored with the assistance of medical imaging to confirm that the bones are knitting, healing evenly, and healing correctly.
When an ORIF is recommended, the patient needs to prepare for surgery. This involves meeting with the anesthesiologist and the surgeon to discuss risks and concerns, following directions such as refraining from eating or drinking before the procedure, and showing up at the hospital at the appointed time. During the surgery, the patient will be given either general anesthesia or regional anesthesia (with sedation). The patient will be offered pain management after the surgery while she or he recovers.
Once bones are set with ORIF, the patient has an opportunity to engage in physical therapy. Usually patients are encouraged to start physical therapy as soon as it is safe and practical to do so, to reduce the risk that their muscles will atrophy. Physical therapy also promotes healing, because exercise stimulates blood flow. Patients may also find that light exercise helps them deal with anxiety and depression, two symptoms which can be encountered in the wake of a major injury and surgery such as ORIF.