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Closed Reduction Internal Fixation of Leg Fracture in Adults

Medically reviewed by Last updated on Jan 5, 2023.


Closed reduction internal fixation (CRIF) of a leg fracture

is a surgery. Your healthcare provider moves the broken bones in your leg, ankle, or foot into correct position. He or she is able to do this without an incision being made over the break. Pins and wires are used to hold the pieces of bone in place. Flexible and non-flexible rods and nails, and metal plates may also be used.

How to prepare for a CRIF:

Your healthcare provider will tell you how to prepare for surgery. He or she may tell you to not eat or drink anything after midnight the night before the surgery. Your healthcare provider will tell you what medicines you should take or not take on the day of surgery.

What will happen during a CRIF:

  • You may be given local anesthesia that numbs the body area where the surgery will be done. With local anesthesia, you will remain awake or lightly sedated during surgery. You may feel pressure or pushing during surgery, but you should not feel any pain. You may, instead, be given general anesthesia to keep you asleep during the surgery. The anesthesia will also keep you pain-free during the surgery. You may be given an antibiotic through the IV to decrease the risk for infection.
  • Your healthcare provider will use x-ray pictures to help him or her move the bones into the correct position. Once the bones are positioned correctly, pins and wires may be used to hold the bones in place. Instead, your healthcare provider may make an incision and place flexible nails or rods. He or she may need to place metal plates to hold the bones in place. The incision will be closed with stitches. Your healthcare provider will apply a splint or half cast over your leg or foot. This will prevent movement and help the bones heal.

What happens after a CRIF:

  • You will be monitored until you are fully awake. You may be taught how to use crutches. You may have numbness for up to six hours after surgery. Take your pain medicine before the numbness wears off.
  • As the swelling decreases you may need to have a full cast placed. When the bone is healed, your healthcare provider may remove the pins, wires, and screws. You will need to participate in therapy. Physical and occupational therapies may help you gain strength and keep complete range of motion in the affected leg. You may need to continue therapy after the break has healed.

Risks of a CRIF:

You may get an infection, or bleed more than expected. You may have an allergic reaction to the devices that are place. The fixation devices may cause fractures in other parts of the bone. You bone may not heal properly. The devices may cause irritation to your skin and tissues. The devices may break or move. You may need another surgery. Nerves, muscles, tendons, or blood vessels may be damaged during a CRIF. You may not have full range of motion of the leg.

Call 911 for any of the following:

  • You suddenly feel lightheaded, short of breath, or have chest pain.
  • You cough up blood.

Seek care immediately if:

  • Your leg feels warm, tender, and painful. It may look swollen and red.
  • You have severe pain, even after you take medicine.
  • Your cast or splint breaks.
  • You cannot move your leg or toes.
  • You have tingling or numbness in your leg or toes.

Contact your healthcare provider if:

  • You have a fever or chills.
  • Your cast or splint gets wet or begins to smell.
  • Your bandage or cast feels too tight or too loose.
  • You have a lot of itching under your cast or splint.
  • You have questions or concerns about your condition or care.


  • Prescription pain medicine may be given. Ask your how to take this medicine safely.
  • Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell your provider if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Self-care after surgery:

  • Apply ice to the area. Ice helps decrease swelling and pain. Ice may also help prevent tissue damage. Use an ice pack or put crushed ice in a plastic bag. Cover it with a towel and place it on your fractured area for 15 to 20 minutes every hour as directed.
    Ice and Elevation
  • Elevate your leg as directed. Raise your leg above the level of your heart as often as you can. This will help decrease swelling and pain. Prop your leg on pillows or blankets to keep it elevated comfortably.
  • Keep your splint or cast dry. Place a plastic bag over the splint or cast before you shower. Tape the bag to your skin to keep water out. Do not soak in a tub or pool.
  • Limit activity. You may not be able to put your full weight on your leg. Use your crutches, walker, or cane as directed. Ask your healthcare provider when you can return to your daily activities and go back to work.
  • Eat foods that contain calcium and vitamin D. Calcium and vitamin D help fractures heal. Examples of high-calcium foods include kale, spinach, salmon, and fortified orange juice or breakfast cereal. Tuna, fortified milk or cheese, egg yolks, and soy milk are examples of vitamin D foods.
  • Do not smoke. If you smoke, it is never too late to quit. Smoking can increase your risk for infection and can slow down healing. Ask your healthcare provider for information if you need help quitting. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.
  • Go to physical therapy as directed. A physical therapist teaches you exercises to help improve movement and strength, and to decrease pain.

Follow up with your healthcare provider as directed:

You may need to have more x-rays to show if the bone is healing. You may need to have your splint or cast replaced after the swelling goes down. Write down your questions so remember to ask them during your visits.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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