Repairing Broken Bone With ORIF

Specialist surgical procedure used to fix fractures

doctor performing fracture surgery
Dana Neely / Getty Images

Open reduction internal fixation (ORIF) is a surgical approach that's used for repairing certain types of bone fractures.

An open reduction is an invasive surgical bone realignment, as opposed to a closed reduction that's done without surgery or an incision. Internal fixation is the surgical insertion of hardware to stabilize and hold the bone in place as it heals.

After ORIF, your recovery will depend on several factors—the severity of your injury, the type of bone involved, your post-operative rehabilitation, and your age.

How ORIF Surgery Is Performed

ORIF is a two-part surgery performed by an orthopedic surgeon, with anesthesia for pain control. The steps are broadly outlined as follows:

  1. The first stage, fracture reduction, is repositioning of the broken bones to restore their normal alignment. This stage is focused on ensuring that the bones are set at the right position, with as few spaces and surface irregularities as possible.
  2. The second stage is the internal fixation. This can involve the use of different types of implants to hold the broken bones together and provide reasonable stability during the healing process.

Internal fixation devices include metal plates and screws, stainless steel pins (Kirschner wires, K-wires), and stabilizing rods that are placed into the cavity of the bone (intramedullary nails, IM nails).

You might have a cast placed after your surgery. Different types of casts may be used during your healing process. You might start with a non-weight-bearing cast to use with crutches for the initial stage of your recovery, followed by a weight-bearing cast as healing advances.

While some orthopedic implants are designed to stay in the body permanently, sometimes a follow-up surgery may be needed to remove an implant that was placed to temporarily support the bone during healing. This is sometimes the case with a severe fracture of the tibia (shin bone) or femur (thigh bone), or when an external device (external fixator) is used.

Post-Operative Care

Physical therapy, as structured by your surgeon and under the care of a ​licensed specialist, can help you safely restore your strength, endurance, and range of motion.​

Immobilization leads to muscle atrophy and weakening of ligaments and tendons. Physical therapy is key to post-recovery success.

Possible Risks

Side effects of ORIF procedures can include bacterial infection, nerve damage, decreased range of motion, and in some cases, arthritis. Shortening of a limb or another deformity may occur—but you could be at risk of these complications if you don't undergo surgery, as well.

Discuss the risks, benefits, and treatment options with your surgeon to determine the best course of treatment for you.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Frangie R. Ankle Fracture: Open Reduction and Internal Fixation. Operative Dictations in Orthopedic Surgery. 2013:231-233. doi:10.1007/978-1-4614-7479-1_64

  2. Rasouli MR, Viola J, Maltenfort MG, Shahi A, Parvizi J, Krieg JC. Hardware Removal Due to Infection after Open Reduction and Internal Fixation: Trends and PredictorsArch Bone Jt Surg. 2015;3(3):184–192

Additional Reading

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.