Definition:

An open reduction and internal fixation (ORIF) is a type of surgery used to fix broken bones. This is a two-part surgery. First, the broken bone is reduced or put back into place. Next, an internal fixation device is placed on the bone; this can be screws, plates, rods, or pins used to hold the broken bone together.

Criteria/ indication for ORIF of fractures: Absolute 1. 2. 3. 4. 5. 6. Unable to obtain an adequate reduction Displaced intra-articular fractures Certain types of displaced epiphyseal fractures Major avulsion fractures where there is loss of function of a joint or muscle group Non-unions Re- implantations of limbs or extremities

Relative 1. 2. 3. 4. 5. 6. 7. Delayed unions Multiple fractures to assist in care and general management Unable to maintain a reduction Pathological fractures To assist in nursing care To reduce morbidity due to prolonged immobilisation For fractures in which closed methods are known to be ineffective

Possible Complications Complications are rare, but no procedure is completely free of risk. If you are planning to have this procedure, your doctor will review a list of possible complications which may include: Infection Bleeding Blood clots

Factors that may increase the risk of complications include: Heart or lung disease History of blood clots Obesity Infection Diabetes

Nursing diagnosis

Risk for infection r/t inadequate primary defenses such as broken skin and traumatized tissue Ineffective tissue perfusion r/t changes in circulating volume Deficient fluid volume r/t loss of blood Risk for peripheral neurovascular dysfunction r/t interruption of blood flow secondary to Blood clots

MEDICAL INTERVENTION Pre-operative management

Since broken bones are caused by trauma or an accident, an ORIF surgery is typically an emergency procedure. Before your surgery, you may have: o Physical examto check your blood circulation and nerves affected by the broken bone o X-ray, CT scan, or MRI scantests that take a picture of your broken bone and surrounding areas o Blood tests o Tetanus shotdepending on the type of fracture and if your immunization is current o Questions your doctor may ask include: How did you break your bone? How much pain do you feel? Do you take any blood-thinning medicines? o Questions you should ask include: Will I need rehabilitation after surgery? What will I need to assist in my recovery (eg, wheelchair, crutches)? An anesthesiologist will talk to you about anesthesia for your surgery. Arrange for a ride home from surgery. If your surgery is urgent, you may not have time to fast beforehand; make sure to tell your doctor and the anesthesiologist when you last ate and drank.

If your surgery is scheduled, you may be asked to stop taking medicines that thin the blood, like warfarin (Coumadin), clopidogrel (Plavix), or aspirin. If surgery is urgent, make sure to let your doctor know if you take any blood-thinners or other medicines.

Anesthesia General anesthesia may be used. It will block any pain and keep you asleep during the surgery. It is given through an IV (needle in your vein) in your hand or arm. In some instances, a spinal anesthetic, or more rarely a local block, may be used to numb only the area where the surgery will be done. This will depend on where the fracture is located and the time it will take to perform the procedure.

Description of Procedure Each ORIF surgery differs based on the location and type of fracture. In general, a breathing tube may be placed to help you breathe while you are asleep. Then, the surgeon will wash your skin with an antiseptic and make an incision. Next, the broken bone will be put back into place. Next, a plate with screws, a pin, or a rod that goes through the bone will be attached to the bone to hold the broken parts together. The incision will be closed with staples or stitches. A dressing and/or cast will then be applied.

Intraoperative ---see video

Post-operative management

After your surgery, you will be taken to the recovery room for observation. If all is well, your breathing tube will likely be removed while you are there. Your heart rate, respirations, blood pressure, and temperature will be checked often. Your pulse and the nerves close to the broken bone will also be checked.

How Long Will It Take? An ORIF surgery can take several hours depending on the fracture and the bone involved.

How Much Will It Hurt? Anesthesia prevents pain during surgery. You will take pain medicine for pain or soreness during recovery.

Average Hospital Stay This procedure is done in a hospital setting. Your length of stay will depend on your surgery. You may be in the hospital for 1-7 days.

Post-procedure Care

At the Hospital

After surgery, you will be given nutrition through an IV until you are able to eat and drink. You will be asked to get out of bed and walk 2-3 times a day to prevent complications. You will begin physical therapy to learn how to move. You will also be shown exercises to regain muscle strength and range of motion. You will be asked to cough and breathe deeply to prevent pneumonia. Your affected limb will be elevated above your heart to decrease swelling. At Home When you return home, do the following to help ensure a smooth recovery:

Change your dressing daily or as instructed by your doctor. If the dressing becomes wet or dirty, change it. Once your dressing is removed, keep your 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 your affected limb often for sense of feeling. Get up and walk several times a day. Continue to do exercises prescribed by your physical therapist. Go to all physical therapy appointments. Be sure to follow your doctors instructions. Call Your Doctor After you leave the hospital, contact your doctor if any of the following occurs:

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 Pain cannot be controlled with the medicines you've been given Always feeling the need to urinate Pain or burning when urinating Blood in the urine Shortness of breath, or chest pain Joint pain, fatigue, stiffness, rash, or other new symptoms