Ankle Fracture Surgery: Understanding the ORIF Procedure

ORIF stands for Open Reduction Internal Fixation. It generally describes fixing a fracture.

What is ORIF surgery?

ORIF surgery is a surgical procedure where an incision is made to open the joints to expose any fracture and to then fix that with either plates or screws, or a combination with plates.

Why ORIF surgery is necessary?

ORIF surgery is generally necessary where there’s major displacement of bones and joint alignment, which would heal in the wrong position, and cause long-term interruption to normal mechanics.

What happens before ORIF?

Sometimes if there’s a lot of swelling, you would wait for the swelling for a few days to perform surgery, but most of the time the sooner this is performed the better. The incision is made over the fracture site and the fracture is reduced into normal anatomical position and screws and plates are used to hold the fracture position, correct alignment, and allow typically six to eight weeks for bones to heal.

Incision exposure

This very much depends on the technique used. Sometimes this can be done through minimal incision which is preferred. This causes less soft tissue trauma, but occasionally with larger fractures a more open exposure may be required.

Bone alignment

Open reduction is where sometimes traction is applied and the joints are temporarily held in position, followed by fixation with plates and screws. The incision is closed with stitches or staples depending on the most appropriate closure.

What happens after ORIF surgery

The bones are immobilised either in a dressing or splint or cast as appropriate depending on the area treated.

Recovery timelines for ORIF surgery

The first two weeks allows for swelling to reduce and most of the healing to occur. There’ll be pain control for the first one to two weeks that’s required.

At two weeks the wounds are checked and the patient is usually carefully mobilised or there’s a change of cast if the limbs are involved.

Between three and six weeks bones begin to heal. Bone healing is usually typically complete between six and 12 weeks and then swelling reduces, you typically start physiotherapy at six weeks.

Remodelling of the areas continues for six to 12 months.

Possible risks and complications

Risk include but are limited to infection, clots, delayed healing, hardware problems, non-union, deeper bone infection, wound closure problems, skin breakdowns, and complex regional pain syndrome.

Conclusion

In conclusion, ORIF in ankle fractures is required to make sure that the ankle alignment is well maintained post injury when there’s been significant displacement. Bones involved are usually the talus, tibia, and fibula.

Frequently asked questions

How long does an open reduction internal fixation take?

This depends on the type of fracture, it may be anything from 30 minutes to many hours.

Is ORIF a major surgery?

It depends on the classification of the ankle fracture, more mild ORIF techniques in the ankle may be percutaneous where there be small displacement or more open surgery may be required, which would be classified as major surgery.

How long does it take to recover from major surgery?

Typically bone healing will take six to eight weeks, wound healing in the first two weeks, and swelling over a six to 12 month period will resolve.

How painful is ORIF surgery?

This again depends on the exact nature of the surgery and the type of fracture that’s treated.

How long until I can walk after surgery?

This depends on whether you’re weight bearing normally within weeks to some extent.