• Open Reduction & Internal Fixation Surgery

    ORIF – fixing broken bones

    What is ORIF surgery?

    An open reduction and internal fixation (ORIF) is a type of surgery used to fix broken bones.

    This is a two-part surgery:

    • First, the broken bone is reduced or put back into place.
    • Next, an internal fixation device is placed on the bone to hold it together. This can be done with screws, plates, rods or pins.

    When is ORIF used?

    This surgery is done to repair fractures that wouldn’t heal correctly with just a cast or splint.

    Possible complications of ORIF surgery

    Problems from ORIF surgery are rare, but all surgical procedures have some risk. Your doctor will review potential problems like:

    • Infections
    • Bleeding
    • Anesthesia reactions
    • Blood clots

    Before your procedure, you should talk to your doctor about how to manage factors that can increase your risk of complications, such as:

    • Smoking
    • Drinking alcohol
    • Chronic disease such as diabetes or obesity
    If you have a history of blood clots, your risk for complications could be increased.

    What to expect before ORIF surgery

    Since broken bones are usually caused by trauma or an accident, ORIF surgery is an emergency procedure in most cases.

    Before your surgery, you may have:

    • Physical exam – to check your blood circulation and the nerves affected by the broken bone
    • Blood tests
    • Tetanus shot – depending on the type of fracture, if your tetanus immunization isn’t current


    If your surgery is urgent, you might not have time to fast beforehand. Please be sure to tell your doctor and the anesthesiologist when you last ate and drank.


    If your surgery is scheduled, you might be asked to stop taking certain medications up to a week in advance of your procedure.


    An anesthesiologist will talk to you about anesthesia for your surgery.

    General anesthesia may be used. This will help block any pain and keep you asleep during the surgery.

    In some cases, a spinal anesthetic, or more rarely a local block, might be used to numb only the area where the surgery will be done. This will depend on where the fracture is located and how long the procedure itself is expected to take.

    What to expect during ORIF surgery

    The typical ORIF procedure

    Every ORIF surgery is different because of the location and type of fracture and, potentially, other personal factors.

    In most cases though, ORIF surgeries follow these general steps:

    1. A breathing tube may be placed to help you breathe while you’re asleep.
    2. The surgeon will wash your skin with an antiseptic and make an incision.
    3. Then, the broken bone will be put back into place.
    4. Next, a plate with screws, a pin or rod that goes through the bone will be attached to the bone to hold the broken parts together.
    5. The incision will then be closed with staples or stitches.
    6. Finally, a dressing and/or cast will be applied.

    Open reduction and internal fixation surgery of the ankle (Image copyright © Nucleus Medical Media)

    How long does ORIF surgery take?

    An ORIF surgery can take several hours, depending on the fracture and the bone involved.

    Does ORIF surgery hurt?

    Anesthesia is used to help prevent pain during surgery.

    Pain and discomfort after the surgery can be managed with medications.

    After an ORIF procedure

    Immediately after your surgery, you’ll be taken to a recovery room for observation.

    There, your blood pressure and breathing will be monitored. Your pulse and the nerves close to the broken bone will also be checked.

    How long will I be in the hospital after ORIF surgery?

    This procedure is done in a hospital setting. Your length of stay will depend on your surgery. You might be in the hospital for 1 to 7 days.

    Post-procedure care in the hospital

    After surgery, you can expect to:

    • Be given nutrition through an IV until you’re able to eat and drink
    • Need to get out of bed and walk 2 or 3 times each day to prevent complications
    • Begin physical therapy to learn how to move during your recovery, as well as to learn exercises that will help you regain muscle strength and range of motion
    • Learn how to properly use any assistance devices, such as a wheelchair or crutches
    • Be asked to cough and breathe deeply to prevent lung problems
    • Have your affected limb elevated above your heart to decrease swelling

    During your stay, your hospital team will take steps to reduce your chance of infection, for example:

    • Washing their hands
    • Wearing gloves or masks
    • Keeping your incisions covered

    There are also steps you can take to reduce your chances of infection, such as:

    • Washing your hands often and reminding visitors and healthcare providers to do the same
    • Reminding your healthcare providers to wear gloves or masks
    • Not allowing others to touch your incisions

    Care when you go home

    Before you leave the hospital, you’ll need to arrange for a ride home.

    You’ll also want to arrange to get help at home from friends and family until you can manage on your own.

    When you return home, do the following to help ensure a smooth recovery:

    • Take care of your bandage or dressing to prevent infection
    • Check your affected limb often for sense of feeling
    • Get up and walk several times a day
    • Continue to do all the exercises prescribed by your physical therapist

    Call your doctor if…

    It’s very important for you to monitor your progress in recovering carefully after you leave the hospital.

    If you experience any of the following problems or potential problems, be sure to alert your doctor right away:

    • Signs of infection, including fever or chills
    • Redness, swelling or increasing pain in the affected limb
    • A lot of bleeding or any discharge (such as pus) from the incision site
    • Loss of feeling in the affected limb
    • Swelling or pain in the muscles around the broken bone
    • Pain that can’t be controlled with the medications you were given
    • Coughing, chest pain or shortness of breath
    • Joint pain, fatigue, stiffness or rash or other new symptoms

    And if you think you’re have an emergency – related to your ORIF procedure or otherwise – call for medical help right away.

    Have questions? Need help finding a doctor?

    Please contact us for:

    • More information or help with questions about Wellmont’s orthopedic services
    • Help finding an orthopedic surgeon

    Or speak to your primary care provider.


    American Academy of Physical Medicine and Rehabilitation www.aapmr.org

    National Institute of Arthritis and Musculoskeletal and Skin Diseases – www.niams.nih.gov


    Fractures (broken bones). Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00139. Updated October 2012. Accessed August 21, 2014.

    Elective total hip arthroplasty. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T566765/Elective-total-hip-arthroplasty. Updated April 11, 2016. Accessed November 16, 2016.

    6/3/2011 EBSCO DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T566765/Elective-total-hip-arthroplasty: Mills E, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

    Revision Information

    This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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