Open Reduction and Internal Fixation
An open reduction internal fixation (ORIF) refers to a surgical procedure to fix a severe bone fracture, or break. “Open reduction” means surgery is needed to realign the bone fracture into the normal position. “Internal fixation” refers to the steel rods, screws, or plates used to keep the bone fracture stable in order to heal the right way and to help prevent infection.
Open reduction internal fixation can also refer to the surgical repair of a joint, such as a hip or knee replacement.
The surgical procedure is performed by a doctor who specialises in orthopaedics, which is a branch of medicine concerning the musculature structure of the body. Under general anaesthesia, an incision is made at the site of the break or injury, and the fracture is carefully re-aligned or the joint replaced. The hardware is installed, and the incision is closed with staples or stitches. The steel rods, screws, or plates can be permanent, or temporary and removed when healing takes place.
Once the open reduction internal fixation is performed, a cast is usually applied. In the case of an ankle fracture, for instance, the first cast is a non-weight bearing cast, and crutches can be used to help keep weight off the healing bones. Later, when the healing has progressed, this cast will be replaced with one that can bear weight. Eventually, after a period of some weeks, the cast will be removed entirely.
A bone graft is a surgical procedure used to fix problems with bones or joints. Bone grafting, or transplanting of bone tissue, is beneficial in fixing bones that are damaged from trauma, or problem joints. It’s also useful for growing bone around an implanted device, such as a total knee replacement. A bone graft may fill a void where bone is absent or help provide structural stability.
The bone used in a bone graft can come from your body, a donor, or it can be entirely man-made. The bone graft can provide a framework where new, living bone can grow if it’s accepted by the body.
The two most common types of bone grafts are:
An allograft uses bone from a deceased donor or a cadaver that has been cleaned and stored in a tissue bank.
An autograft comes from a bone inside your body, such as your ribs, hips, pelvis, or wrist.
The type of graft used depends on the type of injury your surgeon will be repairing. Allografts are commonly used in hip, knee, or long bone reconstruction. Long bones include arms and legs. The advantages are there’s no additional surgery needed to acquire the bone. It also lowers your risk of infection since additional incisions or surgery aren’t required.
External fixation is a surgical treatment used to stabilise bone and soft tissues at a distance from the operative or injury focus. They provide unobstructed access to the relevant skeletal and soft tissue structures for their initial assessment and also for secondary interventions needed to restore bony continuity and a functional soft tissue cover.
The parts of an external fixation include:
1. Schanz pin
2. Connecting rods