ORIF

Written by Dr Sheila Strover on March 14, 2025

ORIF is an abbreviation for 'open reduction and internal fixation', and refers to bone fractures.

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

X-ray of an ankle with a plate and screws

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.

....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."

TK Amin et al

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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.

[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)...."

TK Amin et al

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...."

Mahak Baid et al

....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...."

Salvi Prat-Fabregat et al

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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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