ORIF (Open Reduction Internal Fixation)

Open Reduction Internal Fixation (ORIF) involves the implementation of implants to guide the healing process of a bone, as well as the open reduction, or
setting, of the bone itself. Open reduction refers to open surgery to set bones, as is necessary for some fractures. Internal fixation refers to fixation of screws
and/or plates to enable or facilitate healing. Rigid fixation prevents micromotion across lines of fracture to enable healing and prevent infection, which happens
when implants such as plates (e.g.Dynamic Compression Plate) are used. Internal fixation is an operation in orthopedics that involves the surgical
implementation of implants for the purpose of repairing a bone, a concept that dates to the mid-19th century. An internal fixator may be made of stainless
steel or titanium. Types of internal fixators include bone screws and metal plates, pins, rods, Kirschner wires and intramedullary devices such as the Kuntscher
nail and interlocking nail. Open Reduction Internal Fixation techniques are often used in cases involving serious fractures such as comminuted or displaced
fractures.

Risks and complications can include bacterial colonization of the bone, infection, stiffness and loss of range of motion, non-union, malunion, damage to the
muscles, nerve damage and palsy, arthritis, tendonitis, chronic pain associated with plates, screws, and pins, compartment syndrome, deformity, audible popping
and snapping, and possible future surgeries to remove the hardware.

Indication:

Open reduction internal fixation (ORIF) is an orthopedic surgical procedure which is utilized to treat severe fractures. The hip is a bone which commonly requires
an ORIF procedure after a fracture, although this procedure can be performed on other bones in the body as well. It is usually done in a sterile operating
environment by an orthopedic surgeon with a support team which includes an anesthesiologist to manage the patient along with operating room nurses to assist
with tools, maintenance of a sterile environment, and positioning the patient.

Pre-op Teachings:

Since broken bones are caused by trauma or an accident, an ORIF surgery is typically an emergency procedure. Before your surgery, you may have:

 Physical exam—to check your blood circulation and nerves affected by the broken bone
 X-ray , CT scan , or MRI scan —tests that take a picture of your broken bone and surrounding areas
 Blood tests

When an ORIF is recommended, the patient needs to prepare for surgery. This involves meeting with the anesthesiologist and the surgeon to discuss risks and
concerns, following directions such as refraining from eating or drinking before the procedure, and showing up at the hospital at the appointed time. The patient will
be fully anesthetized during the procedure for comfort and will be offered pain management after the ORIF surgery while she or he recovers.
Procedure:

There are two separate components to an ORIF procedure. The first is the “open reduction” part, which refers to using open surgery to set the bones. Open
surgery may be required when a fracture is complex or there are many pieces of bone. The surgeon makes an incision in the area of the break to access the
involved bone or bones, and manipulates them back into place, checking with an x-ray machine to confirm that the fracture has been fully addressed.

The internal fixation involves the use of pins, plates, and screws to hold the bones in place. This is done because the bones cannot heal with casting or splinting
alone. The internal fixators hold the bones together as they begin to heal. Sometimes they are simply left in place, and in other instances, they may be removed
when healing is complete. Healing is monitored with the assistance of medical imaging to confirm that the bones are knitting, healing evenly, and healing correctly.

Post Procedure Care

• Remove the splint 2 to 4 days after surgery and replace with a removable splint or fracture boot if the bone stock is good and fixation is secure.
• Begin range-of-motion exercises when the splint is removed.
• Restrict weight bearing for 6 weeks
• Change the dressing daily or as instructed by the doctor. If the dressing becomes wet or dirty, change it.
• Once the dressing is removed, keep the incision dry and clean:
o Cleanse the incision site with lukewarm water and mild soap.
o Use a soft wash cloth to gently wipe the incision area.
• Check the affected limb often for sense of feeling.
• Get up and walk several times a day.
• Continue to do exercises as prescribed

Nursing Considerations

Watch for:

• Signs of infection, including fever and chills

• Redness, swelling, increasing pain in the affected limb
• A lot of bleeding or any discharge from the incision site
• Loss of feeling in the affected limb
• Swelling or pain in the muscles around the broken bone