ORIF

Open reduction and internal fixation of a fracture at the ankle.

Fixing a bone fracture with internal 'hardware'

Open reduction and internal fixation refers to the stabilisation of broken bones (fractures) via an open surgical procedure.

In ORIF the surgeon cuts into the joint surgically to align the broken bones and then uses metal surgical plates or other means (loosely referred to as 'hardware') to hold the bones in a better position so that they can heal properly.

• Quote from peer-reviewed papers:

  ....The aim is to achieve and maintain a good reduction of the joint to allow early active mobilisation, thus minimising the joint stiffness and severe muscular atrophy encountered in the conservative treatment."

  Citation: Amin TK, Patel I, Patel MJ, Kazi MM, Kachhad K, Modi DR. Evaluation of Results of Open Reduction and Internal Fixation (ORIF) of Fracture of Distal End of Femur with Intra-Articular Extension. Malays Orthop J. 2021 Nov;15(3):78-83. doi: 10.5704/MOJ.2111.012. PMID: 34966499; PMCID: PMC8667249.

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What kind of fixation is considered 'hardware'?

There are many manufacturers in this field and strong competition between them.

Devices are manufactured from metals and plastics that will withstand normal body forces, and resist breaking themselves, at least for long enough that the fracture can heal.

• Quote from peer-reviewed papers:

  [ORIF devices for distal femur fractures include] "angle blade plate, dynamic condylar screw, less invasive stabilisation system (LISS), intramedullary nails, and distal femoral locking plate (DFLP)...."

  Citation: Amin TK, Patel I, Patel MJ, Kazi MM, Kachhad K, Modi DR. Evaluation of Results of Open Reduction and Internal Fixation (ORIF) of Fracture of Distal End of Femur with Intra-Articular Extension. Malays Orthop J. 2021 Nov;15(3):78-83. doi: 10.5704/MOJ.2111.012. PMID: 34966499; PMCID: PMC8667249.

• Quote from peer-reviewed papers:

  In transverse patellar fractures "....the traditional TBW (tension band wiring) technique, two K wires are proximally bent in a parallel fashion, and a figure-of-eight cerclage wire is then wrapped around them for stabilization...."

  Citation: Baid M, Narula S, Manara JR, Blakeney W. Evolution in the Management of Patella Fractures. J Clin Med. 2024 Feb 29;13(5):1426. doi: 10.3390/jcm13051426. PMID: 38592262; PMCID: PMC10934211.

• Quote from peer-reviewed papers:

  ....tibial plateau fractures are serious injuries, usually associated with soft-tissue complications. Staged treatment is recommended in severe cases. Minimally-invasive osteosynthesis, when possible, is recommended in partial articular fractures....Complete articular fractures can be treated by ORIF or by wire fixators and minimally-invasive osteosynthesis techniques...."

  Citation: Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update. EFORT Open Rev. 2017 Mar 13;1(5):225-232. doi: 10.1302/2058-5241.1.000031. PMID: 28461952; PMCID: PMC5367528.

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Are ORIF plates and screws ever removed?

Once the fracture has healed and the bone is stable, patients often elect to have the 'hardware' removed.

This may include wires as well as plates and screws. Removal is usually managed without problems, unless a lot of time has passed, when removal may prove problematic.

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Forum discussions

• "Metal removal after tibia Plateau fracture 2 years ago"

  Comparing notes after tibial plateau fracture with ORIF.

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