Open reduction internal fixation (ORIF) is a surgery to fix severely broken bones.

It’s only used for serious fractures that can’t be treated with a cast or splint. These injuries are usually fractures that are displaced, unstable, or those that involve the joint.

“Open reduction” means a surgeon makes an incision to re-align the bone. “Internal fixation” means the bones are held together with hardware like metal pins, plates, rods, or screws. After the bone heals, this hardware isn’t removed.

Generally, ORIF is an urgent surgery. Your doctor might recommend ORIF if your bone:

  • breaks in multiple places
  • moves out of position
  • sticks out through the skin

ORIF may also help if the bone was previously re-aligned without an incision — known as closed reduction — but didn’t heal properly.

The surgery should help reduce pain and restore mobility by helping the bone heal in the right position.

Despite the increasing success rate of ORIF, recovery depends on your:

  • age
  • health condition
  • post-surgery rehabilitation
  • severity and location of the fracture

ORIF is performed by an orthopedic surgeon.

The surgery is used to fix fractures in the arms and legs, including bones in the shoulder, elbow, wrist, hip, knee, and ankle.

Depending on your fracture and risk for complications, your procedure might be done immediately or scheduled in advance. If you have a scheduled surgery, you may have to fast and stop taking certain medications first.

Before surgery, you might receive a:

These tests will allow the doctor to examine your broken bone.

ORIF is a two-part procedure. The surgery can take several hours, depending on the fracture.

An anesthesiologist will give you general anesthesia. This will put you in a deep sleep during the surgery so you won’t feel any pain. You might be put on a breathing tube to help you breathe properly.

The first part is open reduction. The surgeon will cut the skin and move the bone back into the normal position.

The second part is internal fixation. The surgeon will attach metal rods, screws, plates, or pins to the bone to hold it together. The type of hardware used depends on the location and type of fracture.

Finally, the surgeon will close the incision with stitches or staples, apply a bandage, and may put the limb in a cast or splint depending on the location and type of fracture.

After ORIF, doctors and nurses will monitor your blood pressure, breathing, and pulse. They’ll also check the nerves near the broken bone.

Depending on your surgery, you may go home that day or you might stay in the hospital for one to several days.

If you have an arm fracture, you may go home later that day. If you have a leg fracture, you might have to stay longer.

Generally, recovery takes 3 to 12 months.

Every surgery is different. Complete recovery depends on the type, severity, and location of your fracture. Recovery can take longer if you develop complications after surgery.

Once your bones begin to heal, your doctor may have you do physical or occupational therapy.

A physical or occupational therapist can show you specific rehabilitation exercises. These moves will help you regain strength and movement in the area.

For a smooth recovery, here’s what you can do at home:

  • Take pain medication. You might need to take over-the-counter or prescription pain medication, or both. Follow your doctor’s instructions.
  • Make sure your incision stays clean. Keep it covered and wash your hands often. Ask your doctor how to properly change the bandage.
  • Lift the limb. After ORIF, your doctor might tell you to elevate the limb and apply ice to decrease swelling.
  • Don’t apply pressure. Your limb may need to stay immobile for a while. If you were given a sling, wheelchair, or crutches, use them as directed.
  • Continue physical therapy. If your physical therapist taught you home exercises and stretches, do them regularly.

It’s important to attend all your checkups after surgery. This will let your doctor monitor your healing process.

Walking after ORIF ankle surgery

After ORIF ankle surgery, you won’t be able to walk for some time.

You can use a knee scooter, seated scooter, or crutches. Staying off your ankle will prevent complications and help the bone and incision heal.

Your doctor will tell you when you can apply weight on the ankle. The time will vary from fracture to fracture.

As with any surgery, there are potential risks and side effects associated with ORIF.

These include:

  • bacterial infection, either from the hardware or incision
  • bleeding
  • blood clot
  • allergic reaction to anesthesia
  • nerve or blood vessel damage
  • tendon or ligament damage
  • incomplete or abnormal bone healing
  • metal hardware moving out of place
  • reduced or lost mobility
  • muscle spasms or damage
  • arthritis
  • tendonitis
  • audible popping and snapping
  • chronic pain due to hardware
  • compartment syndrome, which occurs when there’s increased pressure in the arm or leg



If the hardware gets infected, it might need to be removed.

You may also need to repeat the surgery if the fracture doesn’t heal properly.

These problems are rare. However, you’re more likely to develop complications if you smoke or have medical conditions such as:

To limit your chances of complications, follow your doctor’s instructions before and after surgery.

ORIF isn’t for everyone.

You may be a candidate for ORIF if you have a serious fracture that can’t be treated with a cast or splint, or if you already had a closed reduction but the bone didn’t heal correctly.

You don’t need ORIF if you have a minor fracture. Your doctor might be able to treat the break with closed reduction or a cast or splint.

If you have a serious fracture, your doctor might recommend open reduction internal fixation (ORIF) surgery. An orthopedic surgeon cuts the skin, re-positions the bone, and holds it together with metal hardware like plates or screws. ORIF isn’t for minor fractures that can be healed with a cast or splint.

ORIF recovery can last 3 to 12 months. You’ll need physical or occupational therapy, pain medication, and lots of rest.

You should contact your doctor if you experience bleeding, increasing pain, or other new symptoms during recovery.