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ORIF of an Ankle Fracture


What you need to know about open reduction and internal fixation (ORIF) of an ankle fracture:

ORIF of an ankle fracture is surgery to fix a broken ankle. You may need surgery to repair a talar fracture. The talus is a square, flat bone on top of the heel bone. It connects your heel bone with the tibia and fibula (lower leg bones) to form the ankle. Open reduction means the bones will be put back into the correct position. Internal fixation means hardware (such as wires, screws, pins, or plates) is used to hold the bones in place while they heal.

Heel, toes, ankle

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 after midnight on the day of 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 for 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.
  • You may need blood or urine tests. You may also need x-rays, a CT scan, or an MRI of your ankle and foot. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.

What will happen during ORIF:

  • You will be given general anesthesia to keep you asleep and free from pain during surgery. An incision will be made on or around your ankle. Your surgeon will use wires, screws, plates, or pins to put the broken bones back together. A bone graft may be placed in or around the fracture to make the broken bone stronger. Natural bone will grow around the graft.
  • Your surgeon may flush the area to remove small, loose pieces of broken bone. Damaged blood vessels and nerves will also be repaired. X-rays may be taken to see if the bones are in the correct position. The incision will be closed with stitches or medical tape and covered with bandages.

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 put on your lower leg, ankle, and foot. This will help prevent movement so your bones can heal.
  • Medicines may be given to relieve or prevent pain, nausea, or an infection caused by bacteria.

Risks of ORIF for an ankle fracture:

Nerves, blood vessels, ligaments, or muscles may be damaged during surgery. Your leg, ankle, or foot may become stiff, numb, and weak. You may still have ankle pain. Your broken ankle may not heal properly. You may not be able to walk or move your foot and leg the way you did before your injury. You may have trouble going back to your usual activities. You may develop a life-threatening blood clot.

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

  • You suddenly feel lightheaded and short of breath.
  • You have chest pain when you take a deep breath or cough. You cough up blood.

Seek care immediately if:

  • Your arm or leg feels warm, tender, and painful. It may look swollen and red.
  • Blood soaks through your bandage.
  • Your toes look pale or blue, feel numb, or tingle.

Call your doctor or surgeon if:

  • You have a fever.
  • Your cast or splint breaks or gets damaged or wet.
  • Your cast or splint begins to smell.
  • You have more pain or swelling than you did before the cast or splint was put on.
  • You have questions or concerns about your condition or care.


You may need any of the following:

  • Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely. Some prescription pain medicines contain acetaminophen. Do not take other medicines that contain acetaminophen without talking to your healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your healthcare provider how to prevent or treat constipation.
  • Antibiotics help prevent or fight an infection caused by bacteria.
  • Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her 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.


  • Use crutches as directed. Crutches will decrease the stress on your ankle when you walk. It is important to use crutches correctly. Ask your healthcare provider for more information about how to use crutches.
  • Ask when you can bathe. When you are allowed to bathe, cover your cast with 2 plastic bags. Tape the bags to your skin to keep the water out. Keep the cast out of the water so it does not get wet. If you do not have a cast, carefully wash the wound with soap and water. Dry the area and put on new, clean bandages as directed. Change your bandages when they get wet or dirty.

Cast or splint care:

  • 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.
  • 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 toes are comfortable.

Go to physical therapy, if directed:

A physical therapist teaches you exercises to help improve movement and strength, and to decrease pain.

Follow up with your doctor or surgeon as directed:

You will need to return to have your wound checked and stitches 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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