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What you need to know about open reduction and internal fixation (ORIF):

ORIF is surgery to fix a fractured (broken) bone. Open reduction means that the bone is moved back into the right place with surgery. Internal fixation means that hardware (such as screws, rods, or pins) is used to hold the broken bones together.

Internal Fixation Device

How to prepare for ORIF:

  • Your surgeon will tell you how to prepare for surgery. He or she may tell you not to eat or drink anything 6 to 8 hours before your surgery. Arrange to have someone drive you home after surgery.
  • Tell your surgeon about all medicines you currently take. He or she will tell you if you need to stop any medicine before surgery, and when to stop. He or she will tell you which medicines to take or not take on the day of surgery.
  • Tell your surgeon about all your allergies. Tell him or her if you had an allergic reaction to anesthesia or antibiotics.

What will happen during ORIF:

  • You may be given general anesthesia to keep you asleep and free from pain during surgery. You may be given local anesthesia that numbs the body area where the surgery will be done. With this anesthesia, you will remain awake or lightly sedated during surgery.
  • An incision will be made in the skin over your broken bone. Your surgeon will put the broken bone pieces back together. Metal pins, screws, rods, or plates will be placed into the side of the broken bones to hold them together while they heal. Your incision will be closed with stitches or staples and covered with a bandage.

What to expect after ORIF:

You will be taken to a room to rest until you are fully awake. Healthcare providers will monitor you closely for any problems. Do not get out of bed until your healthcare provider says it is okay. When your healthcare provider sees that you are okay, you will be taken to your hospital room.

  • A cast or splint may be placed to help prevent movement so your bones can heal.
  • Medicines may be given to relieve pain or to prevent nausea or a bacterial infection.
  • A physical therapist may come and help you move the day after surgery. He or she may teach you how to use a walker or crutches. He or she will also give you exercises to do when you go home. After you go home, you will need to continue physical therapy.

Risks of ORIF:

  • Your broken bone may not heal correctly. You may continue to have pain. The hardware may break or change shape. You may need another surgery to remove the device used to hold your bones in place. Nerves, blood vessels, ligaments, or muscles may be damaged during surgery.
  • You may develop a fat embolus. This is fat that travels to other parts of your body. It can block blood flow to your lungs, brain, or heart. You may also develop a life-threatening blood clot.

Call your local emergency number (911 in the US) if:

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

Seek care immediately if:

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

Call your doctor or surgeon if:

  • You have a fever.
  • 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.
  • Your incision is red, swollen, or draining pus.
  • You have questions or concerns about your condition or care.


  • Ask about activity. Do not lift heavy objects. Ask when you can drive and return to work, school, or your daily activities.
  • Use support devices as directed. You may need to use crutches, a cane, or a walker if you had ORIF surgery on your leg or foot. It is important to use crutches or a walker correctly. Ask your healthcare provider for more information about how to use these walking devices.
  • Ask when you can bathe. When you are allowed to bathe, cover your cast or splint with 2 plastic bags. Tape the bags to your skin or use rubber bands to keep the water out. Keep the cast or splint out of the water so it does not get wet. If you do not have a cast or splint, carefully wash the wound with soap and water. Pat the area dry and put on new, clean bandages as directed. Change your bandages when they get wet or dirty. Check the surgery area for signs of infection, such as redness, swelling, or pus.
  • Elevate your limb as directed. Raise your leg or arm above the level of your heart as often as you can. This will help decrease swelling and pain. Prop your leg or arm on pillows or blankets to keep it elevated comfortably.
    Elevate Leg
  • Ice the fractured area as directed. 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 the area for 15 to 20 minutes every hour as directed.
    Ice and Elevation
    Ice and Elevation
  • Go to physical therapy if directed. A physical therapist teaches you exercises to help improve movement and strength, and to decrease pain.

Cast or splint care:

If you have a cast or splint, do the following:

  • Check the skin around the cast or splint every day. Apply lotion on any red or sore areas.
  • Do not push down or lean on any part of the cast or splint. It may break or move the injured area.
  • Do not scratch the skin under the cast with any sharp or pointed object inside the cast.
  • If your splint is too tight, gently loosen it so that your fingers or toes are comfortable.

Follow up with your doctor or surgeon as directed:

You may need to return to have your wound checked and stitches or staples removed. Write down your questions so you 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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