What are the advantages of internal fixation? 

Open reduction and internal fixation (ORIF) is a type of surgery, performed by Orthopedic Surgeon in Doctors Hospital Lahore, for the management of bone fractures. Unlike external fixation, ORIF involves re-attachment of bone through surgery. Read on to know what the procedure entails and what are the advantages of internal fixation over other procedures:

What is ORIF?

Open reduction and internal fixation (ORIF) is the surgical procedure of choice in case of severely broken bones, particularly if there is a clean break and the fracture cannot be treated with splint or cast. In such severe fractures, there is often displacement of bones from their original place, and instability of nearby joints. Consequently, surgery is needed to bring the bones together and binding them in place. 

‘Open reduction’ refers to realigning the bone, while ‘internal fixation’ refers to holding it in place; the latter is done with rods, screws, pins and plates. As the bone heals, the hardware is not removed. 

ORIF is an urgent surgical procedure, which is recommended in the following scenarios:

  • There are multiple breaks in the bone 
  • If the bone is sticking out of the skin 
  • If the bone moves out of position 
  • If the bones were previously re-aligned but they did not heal properly 

The idea of ORIF is to allow the bones to fuse and heal properly, as well as to restore the joint mobility without pain. The recovery of patient with the help of ORIF depends on the overall health of the patient, their age, presence of co-morbid conditions that can impact healing, location and the severity of the bone break as well as the post-surgical rehabilitation through physical therapy.  

What is the post-operative care of ORIF?

With any bone surgery, there is a period of immobilization to allow the bones to heal. Thereafter, rehabilitation is started with physical therapy. This involves movement of the joint with assisted exercises, designed to slowly increase the range of motion. Once these exercises are started, the patient can slowly start their activities of daily living, but there should be no lifting or heavy exertion of the involved joint for a period of at least six weeks. 

Gradually, strengthening and stretching of the joint is begun with resistance exercises under strict monitoring of the physical therapist and healthcare provider. In case of persistent weakness of any involved muscle group, there could be under lying nerve damage, which will be assessed by the healthcare provider. 

What are the risks of ORIF?

In most cases, patients do well after their ORIF surgery. However, rarely there are possible complications such as:

  • Nerve damage either due to the fracture or during the surgery 
  • Excessive bleeding during the surgery or immediately thereafter 
  • Formation of blood clots—thrombus 
  • Fat embolism 
  • Abnormal alignment of the fractured bone and therefore abnormal healing 
  • Infection of the bone 
  • Irritation of the tissue due to internal fixators 
  • Anesthesia complications 
  • Failure of healing, mandating repeat surgery

The risk of these complications is higher in individuals who suffer from chronic health conditions like diabetes and hypertension and those who smoke cigarettes. These factors can compromise the blood flow to the involved bone, thereby slowing healing.

What are the advantages of ORIF?

The biggest benefit of open reduction and internal fixation is the visibility and the open field it allows for the surgeon to perform alignment of the bone. Unlike closed reduction, open reduction is easier when the bone fragments are completely detached and, in such cases, the surgeon can perform optimal reduction. This direct access is not available in closed reduction and may result in malalignment. 

What are the disadvantages of ORIF?

All surgical procedures are associated with some risks and disadvantages. ORIF has increased risk of secondary loss of reduction especially if not performed by an expert like Orthopedic Surgeon in Boulevard Hospital