What is Hip fracture reduction or open reduction and internal fixation (ORIF) of the hip?

Hip Open reduction with internal fixation (Hip ORIF) is the medical process of repairing a very complex or serious hip fracture. This happens if the hip bone suffers such damage or dislocation that it cannot recover independently. Therefore, the bones must be manually corrected by a surgeon. The surgeon will utilize an implant placed in the hip region to hold the bone in place as it heals.

Who may be a candidate for open reduction and internal fixation (ORIF) of the hip?

A fracture is a break in the bone, usually due to falling or an accident or impact. An open fracture has also bruised the overlying skin, doubling the infection risk. The skin may be lost and the bone protruding through the wound. Serious tissue damage and disruption of bone with extensive muscle, tendon, arterial, venous, and nerve injury. Bone fragments, even possibly foreign material like dirt, grass, mud, and clothing, may be present in the wound. The worse the tissue damage and bone disruption, the greater the potential for infection.

In the case of a closed fracture, the bone does not pierce through the skin. Most open fractures result from high impact, including such things as sports injuries, severe falls, and car accidents.

How to be prepared for open reduction and internal fixation (ORIF) surgery?

It is generally performed in an emergency setting because ORIF is usually applied to treat severe fractures. Before surgery, you may experience the following:

• A physical exam to check how blood flow and nerves are affected by the fracture.
• X-ray, CT, or MRI scans to check surrounding structures and the broken bone.
• Blood tests.
• Depending on the type of fracture you have sustained, you will likely receive a tetanus shot if you are not current in terms of immunization.
• A consultation with an anesthesiologist to determine what kind of anesthesia you will receive.
• A consultation with your doctor about medications and supplements you are taking and whether you need to stop.

A guideline to be discussed concerning avoiding food and drink after midnight on the evening before surgery.

What are open reduction and internal fixation (ORIF) procedures?

The ORIF surgery is most commonly used to treat severe hip fractures.

Open reduction and internal fixation (ORIF) is a surgical procedure, usually done under sterile conditions in an operating room under general anesthesia.

• After cleaning the affected area with antiseptics, your surgeon cuts through the thigh's skin and muscles.
• Your surgeon will identify the fracture by sliding gently between the muscles of your thigh.
• Your surgeon will realign the fragments of your femur.
• Your surgeon will stabilize the fragments of your femur to each other with the use of metal plates, screws, wires, or pins.
• For a broken middle section of your femur, your surgeon would use a specific type of metal rod with its crossing middle of the bone and screws to both ends of the bone.
• Any other repairs are also done by your surgeon if required.
• After fixing your bone, your surgeon closes up the incisions with sutures or staples and drapes it with sterile dressings.

What can you expect after the open reduction and internal fixation (ORIF) surgery?

After the procedure, you may experience extreme pain and your physician will prescribe medications for ease. Some patients experience blood clots after the procedure; therefore, a blood thinner might be prescribed to prevent it. You might have X-rays taken to ascertain whether the surgery was successful.

You will receive information about activities that involve weight and posture management. You will also receive information on dressing and incision care. A diet or supplements rich in vitamin D and calcium will be recommended to enhance bone healing. Physical therapy or exercise is encouraged to regain muscle strength, flexibility, and range of movement.

According to the severity of the injury and your health condition, you will be treated and can be discharged on the same day. Follow-up appointments will be scheduled to monitor your progress or have stitches or staples removed when appropriate. Most people resume normal activities within 4 to 6 months following the surgery.

What are the risks and complications associated with open reduction and internal fixation (ORIF) surgery?

With any type of surgical intervention, the following risks and complications occur with open reduction and internal fixation of a hip fracture:

• Bleeding
• Infection
• Thromboembolism
• Nerve injury with damage to blood vessels
• Anesthetic complications
• Hardware irritation
• Fat embolism
• Nonunion of the fracture
• Fracture of the hardware

What are the benefits of undergoing open reduction with internal fixation of the hip?

The benefits of ORIF hip surgery include the following.

• Alleviation of hip pain.
• Properly orientated bone healing
• Restored range of motion
• Ability to ambulate and carry out everyday activities
• The success rate with the healing of bones has been relatively high.

How long does open reduction and internal fixation (ORIF) surgery take to recover?

All of this depends on the type and the severity of the fracture and whether it has become infected. A bone infection can be rather serious and time-consuming, calling for long periods of antibiotic use and several surgical interventions. In more critical cases, if you fail to treat the infection and your life is immediately threatened, then your limb is amputated. That is why it is so important to try not to let an infection occur.

After surgery, the healed bone will be immobilized by a sling, cast, or splint to allow time for the fracture to heal. The actual healing time would depend upon the severity of the fracture and skin damage, if there was infection, and so on, such as your age. You may be given antibiotics after surgery to decrease your chances of developing an infection, and the wound will be checked regularly for signs of infection.

Recovery can be painful, and you will be prescribed painkillers and anti-inflammatory drugs. Pain is normal but should alleviate as the site settles. Physiotherapy is important to help restore the strength of the muscles, ligaments, and tendons and improve range of movement.

What is the long-term impact of open reduction and internal fixation (ORIF) surgery?

The recovery period from ORIF surgery varies between several months to an ability to return to day-to-day activities. You can anticipate feeling stiff, uncomfortable, and sometimes weakened during this time. In nearly all cases, the good news is that you will make a fine recovery, but your consultant will explain that your injury may have some ongoing effect on work, family, and everyday life.

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