Open Reduction & Internal Fixation (ORIF)

Open Reduction and Internal Fixation (ORIF) is a type of orthopedic surgery which uses plates, screws, or rods to restore broken bones.

Open Reduction and Internal Fixation Explained

Open reduction indicates that surgery is required to fix the fractured bone, and internal fixation implies the usage of hardware (screws, plates etc.) to hold the bone in place. That is where the term Open Reduction and Internal Fixation comes from.

The surgery is a two part process:

  1. First, the broken bone is properly positioned back in its original location.
  2. Then, an internal fixation device is surgically fixed to hold the broken bone together.

Internal fixation devices include screws, bolts, pins, metal plates, and rods.


ORIF commonly uses plates and screws.

Why is ORIF Performed?

ORIF is performed to repair severe fractures which cannot be treated with just a splint or cast. Such fractures usually occur during head-on vehicular collisions or similar serious accidents. The bone may be broken in several places and therefore requires something more than just a simple cast or splint.

Even if the fracture is not extensive, if the broken bones stick out of the skin or are misaligned, ORIF may be required to facilitate proper healing. The procedure is complex and it is important to have the necessary equipment and tools in place.

ORIF Procedure

Each ORIF surgery is a unique procedure which varies depending on the extent and site of fracture. General anesthesia is used for sedation and if necessary, a breathing tube may be used for the patient to breathe easily during the course of surgery. Before making the incision, the surgeon will wash the skin with an antiseptic. Through the incision, the broken bones are repositioned and then set in place with the help of hardware such as screws, rods, bolts, and plates. The incision is then closed up and covered with dressing. In some cases, a splint or cast may also be applied to immobilize the joint while healing.

Post-op and Recovery for Open Reduction and Internal Fixation

Immediately after surgery, the patient is taken to the recovery room for close monitoring. The breathing tube is removed if all the vitals are normal. After the initial observation, patient may be hospitalized for 3-7 days. Getting out of the hospital bed and walking around is encouraged to prevent complications and for regaining mobility. To prevent swelling, the affected limb may need to be kept elevated above the heart. It is important for both the patient and the health care team to minimize chances of infection by maintaining cleanliness and keeping the incisions covered.

After being discharged, the following factors must be taken care of in order to have a full recovery for ORIF:

  • Pain management with medications.
  • Keeping the incision clean, dry, and covered in order to avoid infection.
  • Keeping the limb elevated.
  • Not putting a lot of pressure on the infected limb to avoid complications.
  • Continuing the exercises as recommended by the physical therapist.

Most hardware will remain in place permanently as the bone heals and grows around it. Patients usually do not notice any irritation due to the hardware, but if it happens it needs to be addressed. It can take anywhere between 3 to 12 months for complete recovery and for near full functional capacity to be regained.

  • Tarrant County Medical Society
  • TexasMedical Association
  • Texas Orthopaedic Association
  • International Society Of Orthopaedic
  • Western Orthopaedic Association